Alternative and Complementary Treatments for Metabolic Syndrome

Metabolic syndrome is defined by a cluster of cardiovascular disease risk factors that are associated with insulin resistance. In recent years, a number of innovative nutritional strategies have been proposed as safe alternative treatments to reduce the morbidity as well as the cost of treating metabolic syndrome. Of these, dietary supplementation with chromium picolinate or cinnamon extract has been studied most extensively. These interventions may attenuate insulin resistance and reduce the cardiovascular risk factors that together comprise the metabolic syndrome. However, more clinical trials are needed to determine the dose and duration of such treatments to make specific recommendations for populations with metabolic syndrome.     

Herbal Treatments of Asthma: A Systematic Review

Background: Asthma is a condition, often chronic, characterized by respiratory symptoms, variable airflow limitation and/or airway hyper-reactivity with symptoms causally related to family history, environmental influences, exposure to viruses and allergens as examples. The high economic burden associated with asthma is associated primarily with health care costs, missed work or school days. This systematic review was conducted to determine the study quality of articles investigating ayurvedic/collateral herbs, the effectiveness/efficacy and safety profile, as reported in the studies. Methods: Literature searches were conducted using PubMed, EMBASE, Mantis, Ovid, Annotated Bibliography of Indian Medicine, and Cochrane library to identify published trials on herbal medicines for asthma of which Ayruvedic herbals are a subset. Randomized Controlled Trials (RCTs) and Quasi-Experimental Designs (QEDs) were included in this systematic review. The classic Jadad Scale, Singh RCT Scale with additional domains than Jadad, Safety Scoring Scale for clinical trials and the Singh QED Scale based on expanded features of QEDs were used to assess study quality. Herbs included in Traditional Chinese Medicine were excluded from this review. Forty-two articles were retrieved and 37 studies were ultimately reviewed utilizing 3 independent evaluators/1 arbitrator. Results: Articles reviewed indicated benefit from most of the herbs used either as a primary or adjunctive treatment for Asthma. Study quality was mixed and therefore caution in interpretation of findings of usefulness of these herbals must be suggested. Limited safety information was mixed and generally was related to GI symptoms, though one herbal investigated reported more serious side effects. Conclusions: Herbs may be useful in treatment of asthma. There is insufficient evidence to make recommendations for or against the use of these herbals. Established effectiveness must be balanced with study quality and safety profile for the herb.     

A Training Program for Certified Asthma Educators: Assessing Performance

Background. Evidence-based asthma guidelines identify asthma education as an essential element of care. In Canada, a process for certifying asthma educators was established to help provide asthma education to patients. A critical component to certifying asthma educators is their training and evaluation. The purpose of the study was to identify an approach to evaluate participants and to determine if specific characteristics influenced participants' success. Methods. Participants completed a questionnaire that collected demographic, practice, and learner characteristics. Assessment strategies and criteria used to determine the level of success included 1) a written asthma knowledge score; 2) a written educational theory score, and 3) a practice teaching skill score based on three encounters with standardized patients. Standardized patient encounters were scored by using a standard checklist of essential teaching functions. Results. Participants (n = 73) represented a broad range of health professions (respiratory therapists, nurses, pharmacists, and physiotherapists). The average score for written asthma knowledge, educational theory, and practice skill assessment was 82.0 ± 8.0%, 68.6 ± 16.2%, and 80.3 ± 9.7%, respectively. Moderate interrelationships were observed between the practice teaching skills score and years of practice in asthma (r = 0.35; p< 0.01) and percentage of workdays dedicated to asthma care (r = 0.30; p< 0.05). Moderately strong relationships were observed among the three standardized patient encounters. However, there were no associations between participant scores on the written asthma or educational theory examination and the practice skill assessment scores. Conclusions. Participants of an asthma educator training program represent a wide range of disciplines, practice settings, and experience. It is important that asthma educator training programs assess both written knowledge and practice assessments to evaluate participants.     

Assessing the Family Asthma Management System

The importance of “self-management” has been increasingly recognized in the treatment of asthma. In the case of childhood asthma, such management must be accomplished by the family system, including the caregivers, the asthmatic child, and the alternate caregivers in collaboration with the health care providers. This paper presents an assessment tool, the Family Asthma Management System Scale (FAMSS), for evaluating the effectiveness of the family asthma management system. The scale is internally consistent and has excellent inter-rater reliability. The FAMSS score, together with an asthma severity measure, jointly accounted for a significant portion of the variance when predicting the functional severity of asthma experienced by this group of children.     

Assessing the Value of Children's Asthma Camps

The Consortium of Children's Asthma Camps Directors commissioned a study to determine the value of asthma camps. This study aimed to identify the opportunities and the Consortium's role in this future direction. A multi-method, retrospective study was conducted with the following findings: camper demographics; camps provide a unique experience; there is moderate to high level of published evidence regarding children's asthma camps; camps are managed by organizations with extensive experience and by minimal paid staff; and the components of asthma education are fairly consistent across camps, while the duration of education, curricula used, and use of asthma action plans are not.     

Assessing the Value of Children's Asthma Camps

The Consortium of Children's Asthma Camps Directors commissioned a study to determine the value of asthma camps. This study aimed to identify the opportunities and the Consortium's role in this future direction. A multi-method, retrospective study was conducted with the following findings: camper demographics; camps provide a unique experience; there is moderate to high level of published evidence regarding children's asthma camps; camps are managed by organizations with extensive experience and by minimal paid staff; and the components of asthma education are fairly consistent across camps, while the duration of education, curricula used, and use of asthma action plans are not.     

Predicting the Need for Hospital Admission in Patients with Acute Bronchial Asthma

Historical data, physical findings, pulmonary function, arterial blood gases, and subjective degree of dyspnea rated on a modified Borg scale were correlated with eventual requirement of hospitalization in 83 episodes of acute asthma attacks of 70 adult patients. Among the pretreatment data, only pulse rate remained significant by a multivariate analysis to predict hospitalization. For patients who had apparently been successfully treated in the emergency room and discharged home, residual degree of subjective dyspnea was the only significant variable chosen by a linear discriminant function to predict the eventual need for hospitalization, with a sensitivity of 75% and a specificity of 78%. We concluded that careful clinical evaluation still remains the best available diagnostic tool in the care of acute asthma.     

Updated Review of Complementary and Alternative Medicine Treatments for Systemic Lupus Erythematosus

It is estimated that over 50 % of patients with systemic lupus erythematosus (SLE) have utilized complementary and alternative medicine (CAM) treatments to reduce symptoms and manage their health. However, there are relatively few randomized controlled trials of CAM for SLE. This review describes recent studies of vitamins and supplements, acupuncture, and mind-body interventions in SLE patients. The recent trials of CAM treatments for SLE indicate that supplements such as vitamin D, omega 3 fatty acids, N-acetyl cysteine and turmeric show some promise for reducing SLE disease activity. In addition, mind-body methods such as cognitive-behavioral therapy and other counseling interventions may improve mood and quality of life in SLE.     

Assessing Quality of Life for New Diabetes Treatments and Technologies: A Simple Patient-Centered Score

Background

A simple quality of life measure is needed for use in diabetes, particularly for the assessment of new treatments and technologies. We devised and validated a patient-centered quality of life (PCQoL) measure that should be applicable to routine clinical practice or trial of therapies.

Methods

People with diabetes completed a two-part, PCQoL questionnaire where they nominated five aspects of general- and diabetes-related life judged most important for their overall quality of life and rated each for current level of satisfaction. Scores derived from the questionnaire were compared with a reference measure—the Diabetes Control and Complications Trial diabetes quality of life (DQoL) score. Both were repeated after 1 month. The participants were 72 diabetic patients (60% with type 1 diabetes); 29 people with type 1 diabetes were treated by continuous subcutaneous insulin infusion (CSII) and 14 were treated by multiple daily insulin injections (MDI).

Results

Patients most often cited family and relationships or fear of complications and hypoglycemia as important facets of quality of life for them. The PCQoL measure was highly correlated with the reference DQoL measure (r = 0.73, p < 0.0001), had high repeatability (r = 91, p < 0.0001), and could be completed in less than 5 minutes. The test was sensitive enough to detect a better quality of life in CSII-treated patients vs MDI-treated patients.

Conclusion

The PCQoL measure is simple, quick, valid, and suitable for routine use in diabetes or trials of new treatments.     

Assessing Pediatric Clinical Asthma Practices and Perceptions: A New Instrument

Over the past 20 years, the most substantial increases in prevalence, morbidity, and mortality of asthma have been observed among children aged 5-14 years. A survey instrument designed to measure clinical asthma management practices of primary care physicians was developed and evaluated. Study participants included 127 practitioners providing pediatric asthma care in inner-city communities in Baltimore, MD and Washington, DC. Study results found that the instrument assessed four separate dimensions of clinical assessments and five dimensions of physician perceptions. These dimensions should be considered in future research protocols and may be used to design tailored interventions to improve asthma care.     

Patient Characteristics Relevant to Effective Self-Management: Scales for Assessing Attitudes of Adults Toward Asthma

The Asthma Opinion Survey, a 33-item Likert-type instrument, was designed to measure attitudes relevant to self-management in adult outpatients. Items fall into eleven clusters; General Vulnerability, Specific Vulnerability, Attitudes Toward Patient Knowledge, Recognition of Airway Obstruction, Accessibility of Health Care, Panic-Fear, Belief in Treatment Efficacy, Staff-Patient Relationships, Sense of Control, Personal Impact, and Social Impact. Factor analysis of the clusters yielded three factors Vulnerability, Perceived Quality of Care and Recognition and Control. The items, clusters, and factors all had adequate to good score spreads and internal consistencies. Asthma opinions covaried significantly with demographic characteristics, asthma severity, and intensity of health care utilization, and correlated with the Asthma Symptoms Checklist, an instrument developed at the National Jewish Hospital-National Asthma Center, in ways supporting construct validity. These results suggest the Asthma Opinion Survey is achieving its intended purpose.     

Assessing the Perceived Stress Scale for African American Adults with Asthma and Low Literacy

The Perceived Stress Scale (PSS) is a widely used measure of stress that has not been validated in asthma patients. The psychometric properties of the PSS were explored using confirmatory factor analysis and item response theory. Study 1 involved 312 ambulatory care patients with asthma who completed the PSS during a routine visit. Study 2 involved 247 community-dwelling adults with asthma who completed the PSS as a part of a larger asthma study. Four items showed acceptable psychometric performance across ethnic groups and literacy. The short PSS is a rapid, valid measure of subjective stress in diverse asthma populations.     

药物涂层支架负面作用的新认识及防治进展

在2007年召开的TCT大会上,专家们通过临床试验结果说明了药物涂层支架和晚期支架内血栓的关系,药物涂层支架的安全性和有效性再一次得到了证实.但在药物涂层支架的临床应用中仍然存在着贴壁不良、支架断裂等其他问题.因此,关于药物涂层支架安全性的问题争论仍将继续.而在药物涂层支架负面作用的防治上,药物治疗、新型支架的发展等方法也在逐步发展之中.     

Is Exhaled Nitric Oxide a Useful Adjunctive Test for Assessing Asthma?

Rationale. To determine the general utility of clinical (Asthma Control Test) and physiologic (forced expiratory volume in the first second of exhalation [FEV₁] and fractionated exhaled nitric oxide level [FeNO]) parameters for characterizing asthma patients. Methods. Two cross-sectional independent studies simultaneously enrolled 100 patients in the US and 109 patients in Spain ≥ 18 years of age with a physician-diagnosis of asthma and confirmed by a ≥ 12% improvement in FEV₁ after bronchodilators or the presence of airway hyperresponsiveness, a central feature of asthma, as measured by methacholine challenge (PC₂₀ < 10 mg/mL). There was no restriction on asthma severity or treatment. Patients were excluded if they had a diagnosis of chronic obstructive pulmonary disease and/or were current cigarette smokers. Statistical analyses were performed to compare ACT, FeNO, and spirometry within and between sites. Results. Population characteristics revealed significant differences in distributions of age, percent-predicted FEV₁ (%FEV₁), FeNO, inhaled corticosteroid usage, and atopy between the two populations. The Spain site enrolled younger patients with milder asthma, based on higher %FEV₁ values and less frequent treatment with inhaled corticosteroids. At each site, mean FeNO levels decreased as asthma control categories increased, and means were lower in the US. There was a negative correlation between ACT and FeNO that was statistically significant for Spain patients not treated with inhaled corticosteroids. Conclusions. The results of this study support the use of FeNO as an adjunctive tool for assessing asthma primarily in mild inhaled corticosteroid (ICS)-naïve asthma patients. The lack of correlation of ACT with FeNO in this and other studies across the entire population appears to reflect the heterogeneity of asthma patients who have an admixture of asthma severity and treatment regimens making it very difficult to appreciate the nuances of sensitive tests like FeNO.