Andrew Jull

Couch potatoes to jumping beans: A pilot study of the effect of active video games on physical activity in children

The primary objective of this pilot study was to evaluate the effect of active video games on childrens physical activity levels.Twenty children (mean ± SD age = 12 ± 1.5 years; 40% female) were randomised to receive either an active video game upgrade package or to a control group (no intervention). Effects on physical activity over the 12-week intervention period were measured using objective (Actigraph accelerometer) and subjective (Physical Activity Questionnaire for Children [PAQ-C]) measures. An activity log was used to estimate time spent playing active and non-active video games.Children in the intervention group spent less mean time over the total 12-week intervention period playing all video games compared to those in the control group (54 versus 98 minutes/day [difference = -44 minutes/day, 95% CI [-92, 2]], p = 0.06). Average time spent in all physical activities measured with an accelerometer was higher in the active video game intervention group compared to the control group (difference at 6 weeks = 194 counts/min, p = 0.04, and at 12 weeks = 48 counts/min, p = 0.06).This preliminary study suggests that playing active video games on a regular basis may have positive effects on childrens overall physical activity levels. Further research is needed to confirm if playing these games over a longer period of time could also have positive effects on childrens body weight and body mass index.Trial Registration NumberACTRN012606000018516

Randomized clinical trial of honey-impregnated dressings for venous leg ulcers.

The efficacy of honey as a treatment for venous ulcers has not been evaluated, despite widespread interest. This trial aimed to evaluate the safety and effectiveness of honey as a dressing for venous ulcers.

Pentoxifylline for treatment of venous leg ulcers: a systematic review

INTRODUCTION Venous ulcers are usually treated with compression therapy, but, because this treatment may not be effective for some people, adjuvant therapy could be beneficial. We did a systematic review of randomised controlled trials that compared pentoxifylline (with and without compression treatment) with placebo, or other treatments, in patients with venous leg ulcers. METHODS We identified eight trials (547 adults), five of which compared pentoxifylline and compression with placebo and compression (n=445), and three of which compared pentoxifylline alone with placebo (102). Our main aim was to determine whether pentoxifylline, with or without compression, was effective in treatment of venous leg ulcers. Analysis was by intention to treat. FINDINGS Pentoxifylline was more effective than placebo in complete healing or substantial improvement of venous leg ulcers (relative risk 1.49, 95% CI 1.11-2.01). Pentoxifylline with compression was also more effective than placebo and compression in complete healing (1.30, 1.10-1.54). Patients taking pentoxifylline had no more adverse events than those on placebo (1.25, 0.87-1.80). The most frequent adverse event was mild gastrointestinal disturbance (43%). INTERPRETATION Our results suggest that pentoxifylline gives additional benefit to compression for venous leg ulcers, and is possibly effective for patients not receiving compression.

Open-label, phase II study of routine high-flow nasal oxygen therapy in cardiac surgical patients

BACKGROUND Respiratory complications after cardiac surgery increase morbidity, mortality, and length of stay. Studies suggest that routine delivery of positive airway pressure after extubation may be beneficial. We sought to determine whether the routine administration of nasal high-flow oxygen therapy (NHF) improves pulmonary function after cardiac surgery. METHODS A pragmatic randomized controlled trial; participants received either NHF (45 litre min(-1)) or usual care from extubation to Day 2 after surgery. The primary outcome was number of patients with / ratio ≥445 on Day 3 after surgery. The secondary outcomes included atelectasis score on chest X-ray; spirometry; intensive care and hospital length of stay; mortality on Day 28; oxygenation indices; escalation of respiratory support; and patient comfort. RESULTS We randomized 340 patients over 14 months. The number of patients with a / ratio of ≥445 on Day 3 was 78 (46.4%) in the NHF group vs 72 (42.4%) standard care [odds ratio (OR) 1.18, 95% confidence interval (CI) 0.77-1.81, P=0.45]. was reduced at both 4 h post-extubation and at 9 a.m. on Day 1 in the NHF group (5.3 vs 5.4 kPa, P=0.03 and 5.1 vs 5.3 kPa, P=0.03, respectively). Escalation in respiratory support at any time in the study occurred in 47 patients (27.8%) allocated to NHF compared with 77 (45%) standard care (OR 0.47, 95% CI 0.29-0.7, P=0.001). CONCLUSIONS Routine use of NHF did not increase / ratio on Day 3 but did reduce the requirement for escalation of respiratory support. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry www.anzctr.org.au (ACTRN12610000973011).

Parents' and children's perceptions of active video games: a focus group study

Energy expenditure studies have shown that playing Active Video Games (AVGs) is positively associated with increases in heart rate and oxygen consumption. It is proposed that playing AVGs may be a useful means of addressing inactivity and obesity in children. This study explored children’s and parents’ perceptions of AVGs and the likely facilitators and barriers to sustained use of AVGs. Data were gathered using focus group interviews: seven with children, four with adults. Both children and parents reported that AVGs offered a way to increase activity and improve fitness. Barriers to sustained engagement, according to parents, were the cost of AVGs and lack of space in the home to play the games. According to children, the likelihood of long-term engagement with AVGs depended on game content and child age, with AVGs being seen as more appropriate for younger children than teenagers. It would appear that there is potential for AVGs to reduce inactivity in young people. However, barriers to widespread, sustainable adoption would need to be addressed if this potential is to be realized.

Feasibility, design and conduct of a pragmatic randomized controlled trial to reduce overweight and obesity in children: the electronic games to aid motivation to exercise (eGAME) study

BackgroundChildhood obesity has reached epidemic proportions in developed countries. Sedentary screen-based activities such as video gaming are thought to displace active behaviors and are independently associated with obesity. Active video games, where players physically interact with images onscreen, may have utility as a novel intervention to increase physical activity and improve body composition in children. The aim of the Electronic Games to Aid Motivation to Exercise (eGAME) study is to determine the effects of an active video game intervention over 6 months on: body mass index (BMI), percent body fat, waist circumference, cardio-respiratory fitness, and physical activity levels in overweight children.Methods/DesignThree hundred and thirty participants aged 10–14 years will be randomized to receive either an active video game upgrade package or to a control group (no intervention).DiscussionAn overview of the eGAME study is presented, providing an example of a large, pragmatic randomized controlled trial in a community setting. Reflection is offered on key issues encountered during the course of the study. In particular, investigation into the feasibility of the proposed intervention, as well as robust testing of proposed study procedures is a critical step prior to implementation of a large-scale trial.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12607000632493

Active video games: the mediating effect of aerobic fitness on body composition

BackgroundIncreased understanding of why and how physical activity impacts on health outcomes is needed to increase the effectiveness of physical activity interventions. A recent randomized controlled trial of an active video game (PlayStation EyeToy™) intervention showed a statistically significant treatment effect on the primary outcome, change from baseline in body mass index (BMI), which favored the intervention group at 24 weeks. In this short paper we evaluate the mediating effects of the secondary outcomes.ObjectiveTo identify mediators of the effect of an active video games intervention on body composition.MethodsData from a two-arm parallel randomized controlled trial of an active video game intervention (n = 322) were analyzed. The primary outcome was change from baseline in BMI. A priori secondary outcomes were considered as potential mediators of the intervention on BMI, including aerobic fitness (VO2Max), time spent in moderate-to-vigorous physical activity (MVPA), and food snacking at 24 weeks.ResultsOnly aerobic fitness at 24 weeks met the conditions for mediation, and was a significant mediator of BMI.ConclusionPlaying active video games can have a positive effect on body composition in overweight or obese children and this effect is most likely mediated through improved aerobic fitness. Future trials should examine other potential mediators related to this type of intervention.Trial registrationAustralian New Zealand Clinical Trials RegistryWebsite: http://www.anzctr.org.auStudy ID number: ACTRN12607000632493

Responsiveness of generic and disease‐specific health‐related quality of life instruments to venous ulcer healing

The aim of the study was to evaluate the responsiveness of the Short Form Health Survey, the EuroQol 5 Dimension questionnaire, and the Charing Cross Venous Ulcer Questionnaire (CXVUQ) to venous ulcer healing. Participants had health‐related quality of life measured at baseline and 12 weeks. Standardized response means were calculated to assess the responsiveness of the instruments to change in an ulcer state (healed vs. unhealed). Three hundred and sixty‐eight participants completed the questionnaires at baseline and 360 at 12 weeks. One hundred and ninety‐three participants (54%) had healed at 12 weeks. The standardized response means ranged from −0.01 to 0.47 for Short Form Health Survey, 0.10–0.31 for EuroQol 5 Dimension questionnaire, and −0.21 to −0.92 for CXVUQ. Differences between healed and unhealed participants at 12 weeks were significantly different for three of the eight domains on Short Form Health Survey and on all domains for the CXVUQ. There were no significant differences between the groups on the EuroQol 5 Dimension questionnaire scales. CXVUQ was more responsive than the generic instruments to change in ulcer status over 12 weeks for measuring health‐related quality of life of patients with venous ulceration.

Parent-only vs. parent-child (family-focused) approaches for weight loss in obese and overweight children: a systematic review and meta-analysis.

Families are recommended as the agents of change for weight loss in overweight and obese children; family approaches are more effective than those that focus on the child alone. However, interventions that focus on parents alone have not been summarized. The objective of this review was to assess the effectiveness of interventions that compared a parent‐only (PO) condition with a parent‐child (PC) condition. Four trials using a similar between‐group background approaches to overweight and obese childrens weight loss met the inclusion criteria, but only one trial reported sufficient data for meta‐analysis. Further information was obtained from authors. Meta‐analysis showed no significant difference in z‐BMI from baseline to end of treatment between the conditions (three trials) or to end of follow up (two trials). The trials were at risk of bias and no single trial was at lower risk of bias than others. There is an absence of high quality evidence regarding the effect of parent‐only interventions for weight loss in children compared to parent‐child interventions, but current evidence suggests the need for further investigation.

What is the incidence of patients with palliative care needs presenting to the Emergency Department? A critical review

Background: Given the context of ageing populations globally, there are a growing number of patients with chronic conditions, some of whom are in the final stages of their disease trajectory, presenting to Emergency Departments. Aim: The aim was to estimate the incidence of patients with palliative care needs presenting to the department. Methods: Three databases (MEDLINE, CINAHL and Embase) were systematically searched up to August 2012. The reference lists of included articles were searched as well as Google and Google Scholar. Only studies in English were included. Two reviewers independently reviewed studies at the abstract and full-body stages. A critical review using systematic methods was undertaken as statistical analysis could not be done because of a lack of information. Results: Only 10 of 1427 identified records met the inclusion criteria. Different definitions of palliative care were evident. One article provided an incidence density for patients with non-small cell lung cancer, and we calculated the mean presentations to be 52.5 per 100 person-months. Two articles focussed on patients known to palliative care services; we estimated that 2.5 in 1000 Emergency Department visits were made by these patients. The review demonstrated that the studies were so different it was not possible to compare the data. Conclusion: There is an absence of evidence regarding the incidence of patients with palliative care needs presenting to the Emergency Department. Further research needs to be undertaken in this area to ensure both clinicians and policymakers have sufficient information for service provision.