A randomized controlled trial of buprenorphine in the management of short-term ambulatory heroin withdrawal

Aim: To determine whether buprenorphine is more effective than clondine and other symptomatic medications in managing ambulatory heroin withdrawal.
Design: Open label. prospective randomized controlled trial examining
withdrawal and 4-week postwithdrawal outcomes on intention-to-treat.
Setting: Two specialist, out-patient drug treatment centres in inner city
Melbourne and Sydney, Australia.
Participants: One hundred and fourteen dependent heroin users were recruited. Participants were 18 yea rs or over. and with no significant other drug dependence, medical or psychiatric conditions or recent methadone treatment. One hundred and one (89%) participants completed a day 8 research interview examining withdrawal outcomes, and 92 (81%) completed day 35 research interview examining postwithdrawal outcomes.
Interventions: Participants randomized to control (n = 56) (up to 8 days or
clonidine and other symptomatic medications) or experimental (n = 58) (up to 5 days of buprenorphine) withdrawal groups. Following the 8-day withdrawal episode, participants could self-select from range of postwithdrawal options (naltrexone, substitution maintenance or counselling).
Measurements: Retention in withdrawal: heroin use during withdrawl: and
retention in drug treatment 4 weeks after withdrawal.
Secondary outcomes: Withdrawal severity: adverse events, and heroin use in the postwithdrawal period.
Findings: The experimental group had better treatment retention at day 8 (86% versus 57%, P = 0.001, 95% CI for numbers needed to treat (NNT) = 3-8) and day 35 (62% versus 39%, P = 0.02, 95% CI for NNT = 4-18): used heroin on fewer days during the withdralwal programlme (2.6 ± 2.5 versus 4.5 ± 2. 3.
P < 0.001. 95% CI = 1- 2.5 days) and in the postwithdrawal period (9.0±8.2
versus 14.6± 10. P<O.Ol. 95% CI = I .8- 9.4): and reported less withdrawal
severity. No severe adverse events reported.
Conclusions: Buprenorphine is effective for short-term ambulatory heroin
withdrawaI, with greater retention, less heroin use and less withdrawal discomfort during withdrawal: and increased postwithdrawal treatment retention than symptomatic medications.

Does balance or motor impairment of limbs discriminate the ambulatory satus of stroke survivors?

Objective: This study was performed to determine if ambulatory function is governed by motor impairment of limbs or balance ability in subjects with hemiplegia caused by stroke.
Design: Seven patients who walked with physical assistance (FIM(TM) 4) after stroke and 13 who walked independently with assistive devices (FIM 6) were compared with 13 healthy subjects. Motor impairment of limbs was evaluated with the Fugl-Meyer Assessment. The Berg Balance Scale and limit of stability test of the Smart Balance Master were used to evaluate balance ability.
Results: The FIM 6 group and the controls were best differentiated by motor impairment of the paretic limbs and limit of stability in the backward direction. Motor impairment of the upper limb and limit of stability in direction toward the paretic side separated the FIM 4 from the FIM 6 group. Upper limb motor impairment and the Berg Balance Scale consistently separated the three subject groups.
Conclusions: Motor impairment in the paretic upper limb and balance dysfunction should be addressed in treatments working toward independent ambulation.

Comparing the physiological cost of step-powered video gaming, sedentary video gaming and self paced ambulatory activity in university students

Objectives: Methods for converting inactive video gaming to active video gaming have gained popularity in recent years. This study compared the physiological cost of a new peripheral device that used steps to power video gaming in an interactive manner against sedentary video gaming and self-paced ambulatory activity of university students (aged 19-29 years).
Methods: Nineteen adults (9 male, 10 female) performed six 10-minute activities, namely self-paced leisurely walking, self-paced brisk walking, self-paced jogging, two forms of sedentary video gaming, and step-powered video gaming. Activities were performed in a random order. Physiological cost during the activities was measured using Actiheart.
Results: Energy expenditure during step-powered video gaming (388.8 kcal.h-1) was comparable to the energy expended during brisk walking (373.8 kcal.h-1), and elicited a higher energy cost than sedentary video gaming (124.1 kcal.h-1) but a lower energy cost than jogging (694.5 kcal.h-1).
Conclusion: Overall, step-powered video gaming could be used as an entertaining and appealing tool to increase physical activity, though it should not be used as a complete substitute for traditional exercise, such as jogging.

Automated classification of human daily activities in ambulatory environment

This paper presents a human daily activity classification approach based on the sensory data collected from a single tri-axial accelerometer worn on waist belt. The classification algorithm was realized to distinguish 6 different activities including standing, jumping, sitting-down, walking, running and falling through three major steps: wavelet transformation, Principle Component Analysis (PCA)-based dimensionality reduction and followed by implementing a radial basis function (RBF) kernel Support Vector Machine (SVM) classifier. Two trials were conducted to evaluate different aspects of the classification scheme. In the first trial, the classifier was trained and evaluated by using a dataset of 420 samples collected from seven subjects by using a k-fold cross-validation method. The parameters σ and c of the RBF kernel were optimized through automatic searching in terms of yielding the highest recognition accuracy and robustness. In the second trial, the generation capability of the classifier was also validated by using the dataset collected from six new subjects. The average classification rates of 95% and 93% are obtained in trials 1 and 2, respectively. The results in trial 2 show the system is also good at classifying activity signals of new subjects. It can be concluded that the collective effects of the usage of single accelerometer sensing, the setting of the accelerometer placement and efficient classifier would make this wearable sensing system more realistic and more comfortable to be implemented for long-term human activity monitoring and classification in ambulatory environment, therefore, more acceptable by users.

Ambulatory energy expenditure evaluation for treadmill exercises

This paper introduces an ambulatory energy expenditure technique using a single inertial sensor, and compares the performance with an industry standard metabolic measurement system. Wearable energy expenditure estimation systems are key instruments in athlete evaluation. The cost and size of traditional oxygen intake measurement systems (VO2 systems) limits usage of such technology in everyday athlete training and evaluation events. This project describes a method of estimating energy expenditure during treadmill exercise, from limb angular velocity and metabolic measurements. The feasibility of using such a system was evaluated using experimental results.

BioKin: an ambulatory platform for gait kinematic and feature assessment

A platform to move gait analysis, which is normally restricted to a clinical environment in a well-equipped gait laboratory, into an ambulatory system, potentially in non-clinical settings is introduced. This novel system can provide functional measurements to guide therapeutic interventions for people requiring rehabilitation with limited access to such gait laboratories. BioKin system consists of three layers: a low-cost wearable wireless motion capture sensor, data collection and storage engine, and the motion analysis and visualisation platform. Moreover, a novel limb orientation estimation algorithm is implemented in the motion analysis platform. The performance of the orientation estimation algorithm is validated against the orientation results from a commercial optical motion analysis system and an instrumented treadmill. The study results demonstrate a root-mean-square error less than 4° and a correlation coefficient more than 0.95 when compared with the industry standard system. These results indicate that the proposed motion analysis platform is a potential addition to existing gait laboratories in order to facilitate gait analysis in remote locations.

How ophthlamic day surgery patients convalesce at home : an exploration of the salient issues

Cataract surgery is the most commonly performed surgical procedure in Australia. In the next 10-15 years, the number of people needing this surgery is expected to double, This article is based on a study, which explored the types and levels of symptoms experienced by patients post-ophthalmic surgery. Patients were asked to complete two instruments: a 'Postoperative Symptoms Diary' and a follow up 'Telephone Survey Questionnaire'. Eight males and 15 females (n = 23) with a mean age of 80.5 years were recruited. The findings revealed that patients' symptom levels decreased over time, except for tiredness and moving around which increased slightly on Day 4 post-operatively. A carer was required for an average of 2.3 days. This study highlighted the discrepancies in current day surgery literature, which recommend that a carer is needed during only the first 24 hours post-operatively.

Effectiveness of pain management in hospital in the home programs

Alternative health care delivery models such as HITH facilitate the care of patients requiring acute treatments in their own homes. There are over 570 Diagnostic Related Groups managed in HITH programs and many of these are known to have associated physical pain. The impact of the home environment on patients’ experience of pain or how pain is managed is poorly understood. The purpose of this presentation is to
present the background and preliminary findings of a study that aims to increase our understanding of the issues related to providing optimal pain management for acute care patients who are transferred to Hospital in the Home. This knowledge will enable the development of effective practice guidelines to improve patient outcomes. More specifically, the aims are:
• To identify whether patients are transferred to HITH in pain or develop
   significant pain while in the program
• To identify the frequency and intensity of pain experienced by patients in 3      HITH programs.
• To describe patients’ experience of pain in the home environment.
• To investigate whether patients receive adequate pain relief once                      transferred to HITH.
• To explore the strategies patients use to manage pain at home.

The study will be carried out over 12 months in three HITH units in Victoria: Box Hill Hospital, Alfred Hospital and Epworth Hospital. The design is a descriptive survey of patients’ experience of pain and pain management using a modified version of The American Pain Society’s Patient Outcome Questionnaire. 360 consecutive surgical patients transferred to HITH care in the three participating programs will be interviewed by telephone between 48 and 72 hours of admission to the program.

The findings of this study will identify issues in providing optimum pain management for patients receiving acute care in non-traditional treatment environments.

Economic Evaluation of a Primary Care Trial to Reduce Weight Gain in Overweight/Obese Children: The LEAP Trial

Background:- A common policy response to the childhood obesity epidemic is to recommend that primary care physicians screen for and offer counseling to the overweight/obese. As the literature suggests, this approach may be ineffective; it is important to document the opportunity costs incurred by brief primary care obesity interventions that ultimately may not alter body mass index (BMI) trajectory.

Methods:- Live, Eat and Play (LEAP) was a randomized controlled trial of a brief secondary prevention intervention delivered by family physicians in 2002-2003 that targeted overweight/ mildly obese children aged 5 to 9 years. Primary care utilization was prospectively audited via medical records, and parents reported family resource use by written questionnaire. Outcome measures were BMI (primary) and parent-reported physical activity and dietary habits (secondary) in intervention compared with control children.

Results:- The cost of LEAP per intervention family was AU $4094 greater than for control families, mainly due to increased family resources devoted to child physical activity. Total health sector costs were AU $873 per intervention family and AU $64 per control, a difference of AU $809 {P < .001). At 15 months, intervention children did not differ significantly in adjusted BMI or daily physical activity scores compared with the control group, but dietary habits had improved.

Conclusions:- This brief intervention resulted in higher costs to families and the health care sector, which could have been devoted to other uses that do create benefits to health and/or family well-being. This has implications for countries such as the United States, the United Kingdom, and Australia, whose current guidelines recommend routine surveillance and counseling for high child BMI in the primary care sector.

The cost of community-managed viral respiratory illnesses in a cohort of healthy preschool-aged children

Background : Acute respiratory illnesses (ARIs) during childhood are often caused by respiratory viruses, result in significant morbidity, and have associated costs for families and society. Despite their ubiquity, there is a lack of interdisciplinary epidemiologic and economic research that has collected primary impact data, particularly associated with indirect costs, from families during ARIs in children.
Methods : We conducted a 12-month cohort study in 234 preschool children with impact diary recording and PCR testing of nose-throat swabs for viruses during an ARI. We used applied values to estimate a virus-specific mean cost of ARIs.
Results : Impact diaries were available for 72% (523/725) of community-managed illnesses between January 2003 and January 2004. The mean cost of ARIs was AU$309 (95% confidence interval $263 to $354). Influenza illnesses had a mean cost of $904, compared with RSV, $304, the next most expensive single-virus illness, although confidence intervals overlapped. Mean carer time away from usual activity per day was two hours for influenza ARIs and between 30 and 45 minutes for all other ARI categories.
Conclusion : From a societal perspective, community-managed ARIs are a significant cost burden on families and society. The point estimate of the mean cost of community-managed influenza illnesses in healthy preschool aged children is three times greater than those illnesses caused by RSV and other respiratory viruses. Indirect costs, particularly carer time away from usual activity, are the key cost drivers for ARIs in children. The use of parent-collected specimens may enhance ARI surveillance and reduce any potential Hawthorne effect caused by compliance with study procedures. These findings reinforce the need for further integrated epidemiologic and economic research of ARIs in children to allow for comprehensive cost-effectiveness assessments of preventive and therapeutic options.

Review of the role of emergency nurses in management of chemotherapy-related complications

Aims and objectives : To examine the role of emergency nurses in caring for patients who receive chemotherapy in ambulatory oncology settings. Reasons for emergency department presentations are examined, specific sources of clinical risk for patients receiving chemotherapy who require emergency care are discussed and cost implications of emergency department presentations related to chemotherapy are analysed.

Background : Given the increased administration of chemotherapy in ambulatory settings, emergency nurses play an important role in the management of patients undergoing adjuvant chemotherapy. Emergency departments are the major entry point for acute inpatient hospital care of complications arising from chemotherapy.

Design : Systematic review.

Results : Chemotherapy-related emergency department presentations have considerable clinical and cost implications for patients and the healthcare system. Strategies to improve emergency department management of chemotherapy complications and reduction in preventable emergency department presentations has significant implications for improving cancer patients' quality of life and reducing the cost of cancer care.

Conclusions : Nurses are well placed to play a pivotal role in chemotherapy management and lead interventions such as a specialist oncology nursing roles that provide information and support to guide patients through their chemotherapy cycles. These interventions may prevent emergency department presentations for patients receiving chemotherapy in ambulatory settings.

Relevance to clinical practice : Patients receiving chemotherapy require access to specialised care to manage distressing symptoms, as they are at significant clinical risk because of immunosuppression and may not exhibit the usual signs of critical illness. A team approach both within and across nursing specialities may improve care for patients receiving chemotherapy and increase effective use of healthcare resources.