Structured telephone support or telemonitoring programmes for patients with chronic heart failure

BACKGROUND

Specialised disease management programmes for chronic heart failure (CHF) improve survival, quality of life and reduce healthcare utilisation. The overall efficacy of structured telephone support or telemonitoring as an individual component of a CHF disease management strategy remains inconclusive.

OBJECTIVES

To review randomised controlled trials (RCTs) of structured telephone support or telemonitoring compared to standard practice for patients with CHF in order to quantify the effects of these interventions over and above usual care for these patients.

SEARCH STRATEGY

Databases (the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment Database (HTA) on The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED and Science Citation Index Expanded and Conference Citation Index on ISI Web of Knowledge) and various search engines were searched from 2006 to November 2008 to update a previously published non-Cochrane review. Bibliographies of relevant studies and systematic reviews and abstract conference proceedings were handsearched. No language limits were applied.

SELECTION CRITERIA

Only peer reviewed, published RCTs comparing structured telephone support or telemonitoring to usual care of CHF patients were included. Unpublished abstract data was included in sensitivity analyses. The intervention or usual care could not include a home visit or more than the usual (four to six weeks) clinic follow-up.

DATA COLLECTION AND ANALYSIS

Data were presented as risk ratio (RR) with 95% confidence intervals (CI). Primary outcomes included all-cause mortality, all-cause and CHF-related hospitalisations which were meta-analysed using fixed effects models. Other outcomes included length of stay, quality of life, acceptability and cost and these were described and tabulated.

MAIN RESULTS

Twenty-five studies and five published abstracts were included. Of the 25 full peer-reviewed studies meta-analysed, 16 evaluated structured telephone support (5613 participants), 11 evaluated telemonitoring (2710 participants), and two tested both interventions (included in counts). Telemonitoring reduced all-cause mortality (RR 0.66, 95% CI 0.54 to 0.81, P < 0.0001) with structured telephone support demonstrating a non-significant positive effect (RR 0.88, 95% CI 0.76 to 1.01, P = 0.08). Both structured telephone support (RR 0.77, 95% CI 0.68 to 0.87, P < 0.0001) and telemonitoring (RR 0.79, 95% CI 0.67 to 0.94, P = 0.008) reduced CHF-related hospitalisations. For both interventions, several studies improved quality of life, reduced healthcare costs and were acceptable to patients. Improvements in prescribing, patient knowledge and self-care, and New York Heart Association (NYHA) functional class were observed.

AUTHORS' CONCLUSIONS

Structured telephone support and telemonitoring are effective in reducing the risk of all-cause mortality and CHF-related hospitalisations in patients with CHF; they improve quality of life, reduce costs, and evidence-based prescribing.

Observation of a J(PC)=1-+ exotic resonance in diffractive dissociation of 190 GeV/c π- into π- π- π+

The COMPASS experiment at the CERN SPS has studied the diffractive dissociation of negative pions into the π- π- π+ final state using a 190  GeV/c pion beam hitting a lead target. A partial wave analysis has been performed on a sample of 420,000 events taken at values of the squared 4-momentum transfer t' between 0.1 and 1  GeV2/c2. The well-known resonances a1(1260), a2(1320), and π2(1670) are clearly observed. In addition, the data show a significant natural-parity exchange production of a resonance with spin-exotic quantum numbers J(PC)=1-+ at 1.66  GeV/c2 decaying to ρπ. The resonant nature of this wave is evident from the mass-dependent phase differences to the J(PC)=2-+ and 1++ waves. From a mass-dependent fit a resonance mass of (1660±10(-64)(+0))  MeV/c2 and a width of (269±21(-64)(+42))  MeV/c2 are deduced, with an intensity of (1.7±0.2)% of the total intensity.

Macroscopic and microscopic changes in incinerated deciduous teeth

Teeth are amongst the most resilient elements of the human skeleton and are thus often utilized in routine forensic investigation involving the identification of unknown remains. Teeth exposed to thermal stress have the potential to not only aid in identification, but also in understanding the circumstances surrounding the fire. Children are twice as likely to become victims of house fire because of an inability to safely evacuate from areas of danger. The literature demonstrates, however, that research on the effects of incineration on teeth is mostly restricted to the permanent dentition. The apparent lack of knowledge on the effects of incineration on deciduous teeth thus necessitates further research in this area. To this end, this study aimed to relate colour changes that occur post heating with fragility to aid in proper handling of samples in a forensic scenario and to determine the possibility of identifying incineration temperature based on tooth condition. Teeth are amongst the most resilient elements of the human skeleton and are thus often utilized in routine forensic investigation involving the identification of unknown remains. Teeth exposed to thermal stress have the potential to not only aid in identification, but also in understanding the circumstances surrounding the fire. Children are twice as likely to become victims of house fire because of an inability to safely evacuate from areas of danger. The literature demonstrates, however, that research on the effects of incineration on teeth is mostly restricted to the permanent dentition. The apparent lack of knowledge on the effects of incineration on deciduous teeth thus necessitates further research in this area. To this end, this study aimed to relate colour changes that occur post heating with fragility to aid in proper handling of samples in a forensic scenario and to determine the possibility of identifying incineration temperature based on tooth condition. A total of 90 deciduous teeth, extracted as a part of routine clinical treatment, were exposed to temperatures ranging from 100°C to 1100°C for 30 minutes using a laboratory Gallenkamp oven. Unheated deciduous teeth were used as controls for the project. Post-incineration the teeth were analyzed under a stereomicroscope and SEM to assess the morphological changes. A colorimetric assessment was also undertaken to evaluate colour changes due to thermal stress. It was possible to identify incineration temperature based on tooth condition when the colour changes, stereomicroscopic findings and SEM images were utilized collectively. It was concluded that thermally induced changes in primary teeth occur at lower temperatures in comparison to the permanent teeth. It was also established that post-incineration deciduous teeth are fragile and show a tendency to fragment after minimal exposure to thermal stress.

OSETI with STACEE: a search for nanosecond optical transients from nearby stars

We have used the Solar Tower Atmospheric Cherenkov Effect Experiment (STACEE) high-energy gamma-ray detector to look for fast blue-green laser pulses from the vicinity of 187 stars. The STACEE detector offers unprecedented light-collecting capability for the detection of nanosecond pulses from such lasers. We estimate STACEE's sensitivity to be approximately 10 photons/m(2) at a wavelength of 420 nm. The stars have been chosen because their characteristics are such that they may harbor habitable planets, and they are relatively close to Earth. Each star was observed for 10 minutes, and we found no evidence for laser pulses in any of the data sets. Key Words: Search for extraterrestrial intelligence-Optical search for extraterrestrial intelligence-Interstellar communication-Laser.

Measurement of deeply virtual compton scattering beam-spin asymmetries

The beam-spin asymmetries in the hard exclusive electroproduction of photons on the proton (e p-->epgamma) were measured over a wide kinematic range and with high statistical accuracy. These asymmetries result from the interference of the Bethe-Heitler process and of deeply virtual Compton scattering. Over the whole kinematic range (x(B) from 0.11 to 0.58, Q2 from 1 to 4.8 GeV2, -t from 0.09 to 1.8 GeV2), the azimuthal dependence of the asymmetries is compatible with expectations from leading-twist dominance, A approximately a sinphi/(1+c cosphi). This extensive set of data can thus be used to constrain significantly the generalized parton distributions of the nucleon in the valence quark sector.

Is telomere length in peripheral blood lymphocytes correlated with cancer susceptibility or radiosensitivity?

Mean terminal restriction fragment (TRF) lengths in white blood cells (WBCs) have been previously found to be associated with breast cancer. To assess whether this marker could be used as a test for breast cancer susceptibility in women, TRF length was measured in 72 treated female breast cancer patients and 1696 unaffected female controls between the ages of 45 and 77 from the Twin Research Unit at St Thomas' Hospital, as well as 140 newly diagnosed breast cancer cases and 108 mammographically screened unaffected controls from Guy's Hospital. Mean TRF was also tested for correlation with chromosome radiosensitivity and apoptotic response in the Guy's Hospital patients. After adjusting for age, smoking and body mass index, there was no significant difference in TRF lengths between the treated breast cancer patients and unaffected controls (P=0.71). A positive correlation between age-adjusted apoptotic response and mean TRF in newly diagnosed untreated breast cancer patients (P=0.008) was identified but no significant difference in TRF lengths between breast cancer patients and unaffected controls was detected (P=0.53). This suggests that TRF lengths in WBC, is not a marker of breast cancer susceptibility and does not vary significantly between affected women before and after treatment.

Towards automated segmentation and classification of masses in mammograms

This paper presents a straightforward approach to detecting and segmenting mammographic mass cores. The method utilizes adaptive thresholding applied to a contrast-enhanced version of the gray-scale mammogram, where the threshold is a function of the localized gray-level mean and variance. To assess the method's efficacy, it is applied to a database of 62 mammograms, each containing a suspicious mass (39 benign and 23 malignant). Each test case consists of a gray-scale image and a binary image containing a radiologist segmentation of the mass. After segmentation, a variety of features are extracted, including several based on the normalized radial length, rubber band straightening algorithm, gray-level statistics, and patient age. Next, step-wise linear discriminant analysis is utilized for feature reduction and optimization. The same procedure is applied to the manually segmented masses. Analysis of the optimized features resulted in an ROC curve area of Az = 0.8796 and Az = 0.8719 for the automated and manually segmented masses, respectively.

Osteopenia (OP) induced by 6 and 18 months androgen deprivation (AD)

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Background: In a trial evaluating the optimal duration of AD in locally advanced prostate cancer (PC) we sought to determine whether 18 months of zoledronate (Zd) would reverse AD induced OP and reduce bony failure. Methods: In the four arm 2x2 TROG 03.04 (RADAR) trial, men with T2b,c-4 and T2a (Gleason score >6, PSA >10) N0 M0 PC (but without osteoporosis) were randomised to leuprotide (Lp) 22.5 mgs i.m. 3 monthly for 6 months starting 5 months prior to radiotherapy (RT) in Arm A, or the same treatment with Zd mgs i.v.i. 3 months for 18 months commencing on Day 1 (in Arms B and D), or with Lp 22.5 mg i.m. 3 monthly for 12 months after RT (in Arms C and D). Hip and spinal bone mineral densities (BMD) were measured before treatment (bt) and then at 2 and 4 years using DEXA and differences between trial arms were assessed by paired t tests. OP was defined by T- scores <-1. Results: Between October 2003 and January 2006, 930 men were randomized. 124 men with BMD measures bt and at 2 years are evaluable. Mean change (±SD) in BMD between 0 and 2 years was -0.005 ±0.05 (p=0.57) in Arm A, 0.085 ±0.06 (p=<0.001) in Arm B, 0.054 ±0.07 (p=<0.001) in Arm C, and 0.065 ±0.05 (p=<0.001) in Arm D. 98 men had normal BMD bt. Of these 6 of 51 in Arms A, C (no Zd) have developed OP at 2 years while none of 47 in Arms B, D (+Zd) have as yet. Conclusions: At 2 years OP caused by 6 months AD is minimal, but remains significant after 18 months AD. This is reversed by 18 months Zd, but further follow up will determine whether this degree of OP resolves with time or causes fractures.

No significant financial relationships to disclose.

Comparative cohort study of the outcomes of deep lamellar keratoplasty and penetrating keratoplasty for keratoconus

AIM

To compare the outcomes and complications of deep lamellar keratoplasty (DLK) and penetrating keratoplasty (PK) for keratoconus.

METHODS

A cohort of 20 consecutive PKs, for keratoconus, was compared with 20 consecutive DLKs, for keratoconus. The PKs were performed between June 2000 and July 2001, the DLKs between October 2001 and October 2002. Surgery was performed by one surgeon. Best-corrected visual acuities (BCVA), refraction and complications were recorded at the time of surgery, 6 and 12 months postoperatively. chi(2)-tests were used to compare visual acuity outcomes and independent t-tests in the analysis of astigmatism.

RESULTS

Groups were comparable for age, sex, and ethnicity. All PKs were uncomplicated. Two of the DLK group had microperforations of Descemet's membrane. There was no significant difference in the proportion of patients achieving 6/9 or better between the PK and DLK groups (85 vs 78%, P=0.54). PK patients were, however, more likely than the DLKs to achieve 6/6 at 1 year; 70% (14/20) of PKs compared to 22% of (4/18) DLKs (P=0.04). Astigmatism was significantly higher in the PKs compared to the DLKs (P=0.022). There were two cases of graft rejection in the PK group, while none in the DLKs.

CONCLUSIONS

This study confirms good visual results from both PK and DLK in keratoconus with similarly high percentages reaching 6/9 BCVA. DLK appears to cause less astigmatism and also has the advantage of no endothelial graft rejection. The apparent cost, however, is a reduction in the likelihood of achieving 6/6 BCVA.

First measurement of the transverse spin asymmetries of the deuteron in semi-inclusive deep inelastic scattering

First measurements of the Collins and Sivers asymmetries of charged hadrons produced in deep-inelastic scattering of muons on a transversely polarized 6LiD target are presented. The data were taken in 2002 with the COMPASS spectrometer using the muon beam of the CERN SPS at 160 GeV/c. The Collins asymmetry turns out to be compatible with zero, as does the measured Sivers asymmetry within the present statistical errors.

Do Toxoplasma gondii RH strain tachyzoites evolve during continuous passage?

AIM

To examine three lineages of Toxoplasma gondii RH strain in terms of performance in the dye test, culture, and gene expression.

METHODS

Historical data (culture growth and performance in the dye test) from three lineages of RH strain tachyzoites (B, J, and Q) that had been continuously cultured in HeLa cells was assessed. Tachyzoite harvests obtained during continuous cell culture were retrieved from liquid nitrogen and cultured in HeLa cells, providing mRNA that was extracted and used to study gene expression using random amplified polymorphic DNA analysis at different stages of lineage adaptation to continuous culture.

RESULTS

The B and Q lineages consistently produced tachyzoites that were successfully used in the dye test and their gene expression was stable after multiple passages. The J lineage had unpredictable growth, tachyzoites unsuitable for use in the dye test, and changing gene expression with multiple passage.

CONCLUSION

This study has explained some anomalies in the performance of different stocks of T gondii, and suggests that lineages that are still evolving in cell culture should be avoided.

A critique of age estimation using attrition as the sole indicator

The age determination of skeletal remains has been carried out using anthropological examination of the remaining bones and dentition. The aging of the dentition is based on attrition which, if physiological will correlate with age. Occasionally the only material available is a single tooth or a few teeth, or in the case of a living person, teeth in situ. In certain cases microscopic examination of the teeth may not be possible and the age estimation is then often determined by the degree of attrition associated with the tooth. In more recent times the causes of attrition have involved other factors such as bruxism, diet, environment and medication. The weaknesses and limitations of age estimation by examination of dental attrition as the sole indicator of age are highlighted.

The current status of lip prints and their use for identification

The use of lip prints for human identification was first suggested in 1950 and research was carried out on lip prints in the 1960s and early 1970s, resuming in the last few years. Although lip print identification has been utilized in court in isolated cases more research needs to be conducted in this field with regard to confirmation of uniqueness, and the collection and interpretation of evidence. Lip print identification needs to be acceptable in court as scientifically evidence based.

Eta photoproduction on the proton for photon energies from 0.75 to 1.95 GeV

Differential cross sections for gammap-->etap have been measured with tagged real photons for incident photon energies from 0.75 to 1.95 GeV. Mesons were identified by missing mass reconstruction using kinematical information for protons scattered in the production process. The data provide the first extensive angular distribution measurements for the process above W=1.75 GeV. Comparison with preliminary results from a constituent quark model support the suggestion that a third S11 resonance with mass approximately 1.8 GeV couples to the etaN channel.