Victoria Whittaker

Systematic review of long-term lifestyle interventions to prevent weight gain and morbidity in adults

The aim of this article is to determine the effectiveness of long‐term lifestyle interventions for the prevention of weight gain and morbidity in adults. Prevention of weight gain is important in adults who are of normal weight, overweight and obese. A systematic review of controlled trials of lifestyle interventions in adults with a body mass index of less than 35 kg m−2 with at least 2 years of follow‐up was carried out. Eleven of 39 comparisons produced significant improvement in weight between groups at 2 years or longer with mean difference weight change ranging from −0.5 to −11.5 kg. Effective interventions included a 600 kcal/day deficit diet deficit/low‐fat diet (with and without meal replacements), low‐calorie diet, Weight Watchers diet, low‐fat non‐reducing diet, diet with behaviour therapy, diet with exercise, diet with exercise and behaviour therapy. Adding meal replacements to a low‐fat diet (with and without exercise and behaviour therapy) produced significant improvement in weight. Head‐to‐head interventions failed to show significant effect on weight with the exception of a Mediterranean diet with behaviour therapy compared with low‐fat diet. Diet with exercise and/or behaviour therapy demonstrated significant reduction in hypertension and improvement in risk of metabolic syndrome and diabetes compared with no treatment control. Lifestyle interventions demonstrated significant improvement in weight, reduction in hypertension and reduction in risk of type 2 diabetes and the metabolic syndrome.

The association between diet and physical activity and subsequent excess weight gain and obesity assessed at 5 years of age or older: a systematic review of the epidemiological evidence

Background The geographical or natural conditions of a country affect the manner in which economic growth takes place. Overcoming natural impediments and making use of geographical and natural advantages is the duty of economic experts and researchers. In order to overcome geographical and natural hardships, investments above international norm are needed and, on the contrary, by the optimal use of natural and regional advantages of a given area, less investment is needed for economic growth. In spite of all defeats and victories, ups and downs, the inhabitants of this land have relatively always played a determining role in West Asia and have greatly influenced and being influenced by the neighboring events and nation. The Iranian territory is located inside the desert belt of the Northern Hemisphere and is geographically placed in a belt line, the same as the plains in North Africa, Tibet and Turkistan. The country of Iran is about 1648195 square kilometers. From the total 1648195 square kilometers of the Country nearly 509442 square kilometers are used in agriculture and the rest is uncultivable areas or covered by cities, villages, lakes and roads. From 31% cultivable land in Iran; the two Northern provinces on the Caspian Sea coasts with an area of 5.5% of the overall area of Iran form more than 20% of the cultivable lands. 11 Introduction Obesity arises from a complex interplay between genetic susceptibility and behaviour, primarily relating to dietary habits and physical activity (Foresight, 2007). Evidence for specific behavioural factors that promote or protect against excess weight gain have been usefully reviewed (Wareham, 2007); (Jebb, 2007), and is more limited in children compared with adults (Rennie et al., 2005). A number of behavioural risk factors have been postulated, including TV viewing, diets with a high energy density, and fast foods. Most evidence is derived from cross sectional studies which can frequently produce conflicting results. Prospective studies with accurate measure of diet and physical activity exposures, and outcomes in terms of body fatness, are deemed to provide the more robust evidence on which to base interventions to achieve long-term behavioural change and prevent excess weight gain. The question to be answered by this comprehensive systematic review of the epidemiological evidence was ‘What is the association between food, food groups, nutrition and physical activity and subsequent excess weight gain and obesity in humans?’ Relevant exposures include patterns of diet; breastfeeding; food and drink; food preparation; dietary constituents; physical activity and inactivity; energy intake; energy density of diet; energy expenditure. Outcomes in adulthood and childhood have reported separately. Outcomes of interest included markers of weight gain; overweight; obesity; markers of body composition; markers of distribution of fat. The results of this review will provide evidence of association, but not causes, of subsequent excess weight gain and obesity. There is a degree of uncertainty inherent in epidemiological evidence, given that it is impossible to determine if there are uncontrolled variables, including genetic variations. The well known association between relatively high non caloric sweetner usage and subsequent weight gain is a useful reminder that, whilst an evidence based approach is critical to the process of scientific enquiry, consideration of evidence from other types of studies (mechanistic studies, intervention studies) and understanding the context of the evidence reviewed is essential if we are to provide policy makers, industry, service providers and the public with sensible recommendations.

Prospective, randomised, controlled trial to study the effect of intracoronary injection of verapamil and adenosine on coronary blood flow during percutaneous coronary intervention in patients with acute coronary syndromes

Objectives: To study the impact of injection of verapamil and adenosine in the coronary arteries on TIMI (Thrombolysis in Myocardial Infarction) frame count (TFC) after percutaneous coronary intervention (PCI) in patients with an acute coronary syndrome (ACS). Methods: Prospective, randomised, controlled study of the intracoronary administration of normal saline versus verapamil versus adenosine in patients undergoing PCI in the setting of an ACS, even when flow is visually established to be normal or near normal. Patients were randomised to receive verapamil (n  =  49), adenosine (n  =  51) or normal saline (n  =  50) after PCI. Quantitative angiography, TIMI flow grade (TFG), TFC and myocardial blush grade were assessed before PCI, after PCI and after drugs were given. Wall motion index (WMI) was measured at days 1 and 30. Results: 9 patients in the verapamil group developed transient heart block, not seen with adenosine (p ⩽ 0.001). Compared with saline, coronary flow measured by TFC improved significantly and WMI improved slightly but insignificantly in both the verapamil (TFC: p  =  0.02; mean difference in improvement in WMI: 0.09, 95% confidence interval (CI) 0.015 to 0.17, p  =  0.02) and the adenosine groups (TFC: p  =  0.002; mean difference in improvement in WMI: 0.08, 95% CI 0.004 to 0.16, p  =  0.04). The improvements in TFC and WMI did not differ significantly between the verapamil and the adenosine groups (TFC: p  =  0.2; mean difference in improvement in WMI: 0.01, 95% CI −0.055 to 0.08, p  =  0.7, respectively). Conclusion: Administration of verapamil or adenosine significantly improves coronary flow and WMI after PCI in the setting of an ACS. Flow and WMI did not differ significantly between verapamil and adenosine but verapamil was associated with the development of transient heart block.

Selecting the most appropriate inferential statistical test for your quantitative research study

AIMS AND OBJECTIVES To discuss the issues and processes relating to the selection of the most appropriate statistical test. A review of the basic research concepts together with a number of clinical scenarios is used to illustrate this. BACKGROUND Quantitative nursing research generally features the use of empirical data which necessitates the selection of both descriptive and statistical tests. Different types of research questions can be answered by different types of research designs, which in turn need to be matched to a specific statistical test(s). DESIGN Discursive paper. METHODS This paper discusses the issues relating to the selection of the most appropriate statistical test and makes some recommendations as to how these might be dealt with. CONCLUSION When conducting empirical quantitative studies, a number of key issues need to be considered. Considerations for selecting the most appropriate statistical tests are discussed and flow charts provided to facilitate this process. RELEVANCE TO CLINICAL PRACTICE When nursing clinicians and researchers conduct quantitative research studies, it is crucial that the most appropriate statistical test is selected to enable valid conclusions to be made.

Impact of catheter sizes and intracoronary glyceryl trinitrate on the TIMI frame count when digital angiograms are acquired at lower frame rates during elective angiography and PCI

The TIMI frame count (TFC) is a useful measure of coronary flow. To be widely applicable, the effect of different catheter sizes and the use of intracoronary glyceryl trinitrate (ICGTN) must be determined when films are acquired at lower acquisition rates (12.5 frames/s, f/s). Methods: We compared 6F versus 5F diagnostic catheters (n = 44), 6F versus 7F diagnostic catheters (n = 45) and 6F diagnostic versus 7F guide catheters (n = 44). In the nitrate angiography group (n = 141), coronary angiography was performed before and after 200 micrograms of ICGTN. In the nitrate percutaneous coronary intervention (PCI) group (n = 48), coronary angiography was performed before and after 200 micrograms of ICGTN after the completion of the elective PCI procedure. Results: The mean difference in the uncorrected TFC using 6F and 5F was 0.02 (95 % CI −0.5, 0.6; P = 0.9); using 6F and 7F diagnostic catheters it was 0.3 (95% CI −0.49, 1.1; p = 0.4); and using 6F diagnostic and 7F guide catheters it was 0.4 (95% CI −2.6, 3.4; P = 0.7) respectively. In the nitrate angiography group, the uncorrected TFC before and after ICGTN was 13.1±6.2 and 15±7.5 (equivalent to 31.4±14.9 and 36±2 at 30 f/s), with a mean difference of 1.9 (95% CI 1.3, 2.5; P = <0.0001). In the nitrate PCI group, the uncorrected TFC before and after ICGTN administration was 9.2±3.7 and 10.3±4.2 (equivalent to 22.6±9.6 and 25.2±11 at 30 f/s) respectively with a mean difference between the two injections of 1.2 (95% CI −0.4, 1.9; P = 0.003). Conclusion: We have demonstrated that the catheter sizes did not significantly affect the TFC when angiography was performed at 12.5f/s. The use of ICGTN significantly increased the TFC in both normal and diseased coronary arteries. This effect was also observed when ICGTN was administered into the culprit vessels after the completion of the elective PCI procedure. This effect must be considered when investigating the impact of specific treatments or drugs on coronary flow.

The impact of chronically diseased coronary arteries and stenting on the corrected TIMI frame count in elective coronary angiography and percutaneous coronary intervention procedures.

The impact of chronic coronary obstructions on resting blood flow in stable cardiac patients and the response to percutaneous coronary intervention (PCI) using the TIMI frame count method has not been well documented. We studied the impact of coronary artery stenosis severity on the corrected TIMI frame count (cTFC) in chronically stenosed coronary arteries. We prospectively and quantitatively determined the impact of stenting on the cTFC during elective PCI. Methods: In substudy 1, analysis was performed to obtain the mean cTFC for arteries with <50% stenosis (Group A), 51–75% stenosis (Group B), 76–85% stenosis (Group C1), 86–95% stenosis (Group C2) and 96–99% stenosis (Group C3). In substudy 2, the cTFC and quantitative coronary angiography were performed pre‐ and post‐PCI. Results: In substudy 1, the cTFC increased exponentially beyond a diameter stenosis of 75% (P < 0.01). However there was no significant difference in the cTFC for coronary arteries with <75% stenosis. In substudy 2, the overall pre‐ and poststenting cTFC was 17.1 ± 11.7 and 7.8 ± 2.7 (P < 0.01) and the TFC index [calculated by dividing the mean cTFC for the relevant artery by the mean cTFC for the corresponding coronary artery in a previously derived control group in our laboratory] was 1.6 ± 1 and 0.7 ± 0.2 (P = < 0.01), respectively. Conclusion: We have demonstrated that there was a significant increase in the cTFC when the coronary artery stenosis was more than 75% reflecting significant flow abnormalities at this degree of stenosis in chronically diseased coronary arteries. Following stenting there is a significant improvement in the cTFC, which is better than the cTFC for arteries with normal flow, suggesting early hyperaemia.

Surgical versus non-surgical interventions for adolescent idiopathic scoliosis: a Cochrane review protocol

Background The main aims of all clinical interventions in the treatment of adolescent idiopathic scoliosis (AIS) are to limit curve progression, restore trunk balance and prevent long-term consequences of the deformity. Two separate Cochrane reviews have already reviewed the effects of non-surgical interventions (Negrini, 2010 and Romano, 2012). A further scoping search identified four systematic reviews, however full methodological appraisals within these reviews were very limited (Weiss, 2008), indicating the need for a high-quality Cochrane review focusing on surgical interventions.