Recent Publications by CFE Educators

OBJECTIVE

To compare bleeding patterns after immediate vs. conventional oral contraceptive (OC) initiation.

DESIGN

Randomized controlled trial.

SETTING

University-based clinic.

PATIENT(S)

One hundred thirteen women initiating combination OCs.

INTERVENTION(S)

Participants received a 4-month supply of a monophasic 35-microg ethinyl E(2) (EE) OC and a bleeding diary, were randomized to immediate or conventional OC start, underwent monthly telephone follow-up, and after 90 days returned the diary and completed an exit interview.

MAIN OUTCOME MEASURE(S)

Total number of bleeding-spotting days, using the World Health Organization 90-day reference period method. Comparisons were made by trial assignment (immediate vs. conventional) and cycle day of OC initiation (day 8+ vs. days 1-7).

RESULT(S)

There was no significant difference in the number of bleeding-spotting days (mean difference: -0.5 days; 95% CI: -3.4 to 2.3) or any other bleeding parameter between the immediate and conventional starters, or days 1-7 and day 8+ starters.

CONCLUSION(S)

Immediate start of OCs does not induce bleeding patterns different from conventional starting regimens. Concern about adverse bleeding patterns should not be considered a justification for instructing women to wait until menses before starting OCs.

STUDY OBJECTIVES

To determine how frequently patients attending a lung cancer clinic use the Internet for their own health information, to determine whether there are demographic differences between Internet users and nonusers, and to determine how patients compare the quality of Internet information with other sources of lung cancer information.

DESIGN

Sequentially administered patient questionnaire. One hundred eighty-four patients were surveyed, and 139 patients (75.5%) completed the questionnaire.

SETTING

A multidisciplinary thoracic oncology clinic in a Midwestern University hospital.

PATIENTS OR PARTICIPANTS

Patients attending the multidisciplinary thoracic oncology clinic over a 3-month period.

MEASUREMENTS AND RESULTS

The Internet was the most commonly used nonphysician source of information among our patients. Sixteen percent of the patients sought information on the Internet, but 60% expressed interest in using the Internet for information. Users were on average of higher income level and educational attainment but did not differ from nonusers by community size. Internet users rated the quality of information available on the Internet of similar quality to information from all sources.

CONCLUSIONS

Older patients are increasing using the Internet for self-education in lung cancer. While certain barriers continue to exist, patients from rural areas use the Internet to the same degree, as do patients from urban areas. Patients do, however, overrate the quality of information on the Internet.

CONTEXT

The increasing prevalence of obesity is a major public health concern. Physical activity may promote weight and body fat loss.

OBJECTIVE

To examine the effects of exercise on total and intra-abdominal body fat overall and by level of exercise.

DESIGN

Randomized controlled trial conducted from 1997 to 2001.

SETTING AND PARTICIPANTS

A total of 173 sedentary, overweight (body mass index > or =24.0 and >33% body fat), postmenopausal women aged 50 to 75 years who were living in the Seattle, Wash, area.

INTERVENTION

Participants were randomly assigned to an intervention consisting of exercise facility and home-based moderate-intensity exercise (n = 87) or a stretching control group (n = 86).

MAIN OUTCOME MEASURE

Changes in body weight and waist and hip circumferences at 3 and 12 months; total body, intra-abdominal, and subcutaneous abdominal fat at 12 months.

RESULTS

Twelve-month data were available for 168 women. Women in the exercise group participated in moderate-intensity sports/recreational activity for a mean (SD) of 3.5 (1.2) d/wk for 176 (91) min/wk. Walking was the most frequently reported activity. Exercisers showed statistically significant differences from controls in baseline to 12-month changes in body weight (-1.4 kg; 95% confidence interval [CI], -2.5 to -0.3 kg), total body fat (-1.0%; 95% CI, -1.6% to -0.4%), intra-abdominal fat (-8.6 g/cm2; 95% CI, -17.8 to 0.9 g/cm2), and subcutaneous abdominal fat (-28.8 g/cm2); 95% CI, -47.5 to -10.0 g/cm2). A significant dose response for greater body fat loss was observed with increasing duration of exercise.

CONCLUSIONS

Regular exercise such as brisk walking results in reduced body weight and body fat among overweight and obese postmenopausal women.

Careful histopathological evaluation has shown the traditionally clinical diagnosis of idiopathic interstitial pneumonia to be more heterogeneous than once thought. Its subclassification, based on clinicopathological criteria, has important therapeutic and prognostic implications. The most important distinction is the presence of usual interstitial pneumonia, the histopathological pattern seen in idiopathic pulmonary fibrosis. Idiopathic pulmonary fibrosis has a worse response to therapy and prognosis. New insight into the pathophysiology of idiopathic pulmonary fibrosis suggests a distinctly fibroproliferative process, and antifibrotic therapies show promise. Although the clinical and radiographic diagnosis of idiopathic pulmonary fibrosis can be made confidently in some cases, many patients require surgical lung biopsy to determine their underlying histopathological pattern. A structured, clinicopathological approach to the diagnosis of idiopathic interstitial pneumonia, with particular attention to the identification of idiopathic pulmonary fibrosis, ensures proper therapy, enhances prognosis, and allows for further investigation of therapies aimed at the distinct pathophysiology.

OBJECTIVE

To study the effect of highly active antiretroviral therapy (HAART) with and without hydroxyurea (HU) on changes in plasma viral load (VL) set-point, and on HIV-1-specific responses, after five cycles of structured treatment interruptions (STI).

METHODS

A group of 20 patients taking HAART for chronic HIV infection with VL 20 copies/ml were randomized to continue HAART or HAART plus HU for 24 weeks followed by five STI cycles. HU was also stopped in cycles 1-3 but continued in cycles 4 and 5. The number of individuals maintaining a VL set-point 5000 copies/ml during the fifth interruption were determined.

RESULTS

VL remained 5000 copies/ml in eight out of nine patients in the HU group and in four out of ten patients in the HAART group after a median 48 weeks of follow-up after the fifth interruption ( P=0.039). By STI cycle 5, there was a significant increase in the neutralizing activity (NA), in both magnitude and breadth of the total cytotoxic T lymphocyte (CTL) response and in lymphoproliferative response (LPR) from baseline. No significant differences were observed between HAART and HU groups in NA, CTL and LPR at any time-point. There were no differences in the NA titers at any time-point between responder and non-responder patients. There was a trend for higher CTL and LPR levels in responder patients (P= 0.10).

CONCLUSIONS

In this randomized, controlled study of STI with cycles of HAART or HAART plus HU, a lower peak VL rebound and a lower VL set-point was achieved in patients continuing HU while other drugs were discontinued. HU did not blunt anti-HIV-1-specific responses; however, control of VL did not correlate with anti-HIV-1-specific cellular immune responses.

Subunit non-selective N-methyl-D-aspartate (NMDA) receptor antagonists reduce injury-induced pain behavior, but generally produce unacceptable side effects. In this study, we examined the antinociceptive and motor effects of cone snail venom-derived peptides, conantokins G and T (conG and conT), which are selective inhibitors of the NR2B or NR2A and NR2B subtypes of the NMDA receptor, respectively. We tested the effects of conG and conT in models of tissue (formalin test), nerve injury (partial sciatic nerve ligation) and inflammation-induced (intraplantar Complete Freund's Adjuvant; CFA) pain in mice. In the formalin test, intrathecal (i.t.) conG or conT suppressed the ongoing pain behavior (ED(50) and 95% confidence intervals (CI), 11 (7-19) and 19 (11-33), respectively) at doses that were 17-27 times lower than those required to impair motor function (accelerating rotarod treadmill test: ED(50) and 95% CI, 300 (120-730) and 320 (190-540) pmol, respectively). By comparison, SNX-111, an N-type voltage-sensitive calcium channel antagonist that is also derived from cone snail venom, produced significant motor impairment at a dose (3.0 pmol, i.t.) that was only partially efficacious in the formalin test. Furthermore, conG reversed the allodynia produced by nerve injury, with greater potency on thermal (ED50 and 95% CI, 24 (10-55) pmol) than on mechanical allodynia (59 (33-105) pmol). Finally, a single dose of conG (100 pmol, i.t.) also reduced CFA-evoked thermal and mechanical allodynia. Taken together, these results demonstrate that conantokins exhibit potent antinociceptive effects in several models of injury-induced pain. The study supports the notion that drugs directed against subtypes of the NMDA receptor, by virtue of their reduced side-effect profile, hold promise as novel therapeutic agents for the control of pain.

Thyroid nodules are found in 4 to 7% of the population, and with the increased use of radiographic methods, incidental nodules are becoming more prevalent. Only 5% of all nodules will be malignant, and thyroid cancer accounts for only 0.4% of all cancer deaths. The preferred diagnostic approach is early referral, avoidance of numerous radiologic evaluations, and early performance fine-needle aspiration. This article reviews the literature of the last 12 months and discusses some of the new molecular, genetic, and immunostaining techniques in the evaluation of thyroid nodules.