3-month Courses Research Articles

Evaluation of the psychosocial needs of post-radiotherapy rectal cancer survivors and their direct caregivers in Hong Kong: A pilot study.

504 Background: Colorectal cancer is the second most common cancer in Hong Kong. Radiotherapy has been established as an indispensable component during treatment of rectal cancer. Radiation-induced adverse effects are common for radiotherapy patients, severely affecting the quality of life of both the patients and their caregivers. Although previous studies have demonstrated the impacts of radiation-induced adverse effects on the quality of life of rectal radiotherapy patients, little were studied about the impacts on the patients’ and their direct caregivers’ psychosocial health. As there was no previous similar study done in local context, this research serves as a pilot study for improving the understanding of psychosocial needs and quality of life of rectal radiotherapy patients and their direct caregivers in Hong Kong. Methods: This study was a prospective and observational research. Rectal radiotherapy patients and their direct caregivers were recruited from Princess Margaret Hospital, Hong Kong from 2022 to 2023. The primary endpoint was the questionnaire assessment of psychosocial needs and quality of life of rectal radiotherapy patients and their direct caregivers before and after radiotherapy treatment. Questionnaires in different versions for the patients and their direct caregivers before radiotherapy treatment, 3-month and 6-month post-radiotherapy courses were distributed. Results: Twenty-four subjects were recruited, including 13 patients and 11 caregivers. The results show that rectal radiotherapy patients worried about their health in the future. Their direct caregivers’ emotional and intimate lives were affected. Nevertheless, the patients’ health and quality of life improved throughout the post-treatment period. For the caregivers, their feelings of anxiety and depression improved throughout the follow-up period. Conclusions: Most of the results are consistent with previous studies. This study provides a knowledge foundation and research direction for future studies. More future studies with a larger subject number are highly encouraged to solidify the knowledge on psychosocial needs and to improve the care of the patients and caregivers.

Changes in the main dental parameters of preschoolers with caries affected by long-term probiotic intake

Relevance. For several decades, they have added bacteria called probiotics to some foods for their positive effects on human health. In dental practice, probiotics may help fight caries and inflammatory periodontal diseases. Dentists are interested in probiotics because of the latter’s ability to adhere to and colonize various oral tissues.Purpose. To evaluate the clinical effectiveness of S. salivarius M18 probiotic in preschool children.Material and methods. The study formed 2 groups (45 children in each) of children aged 3 to 6 years with multiple dental caries who underwent dental treatment and 4-fold fluoride varnish application. The main group took 2 courses of S. salivarius M18 probiotic lozenges (the 1st course from February 16 to May 16, 2021, and the 2nd course from October 26, 2021, to January 26, 2022). The children of the comparison group did not use the probiotic. We evaluated the Hygiene Index by Fedorov-Volodkina, dmf(t) rate, ICDAS-II index, and PMA index in children of both groups at the baseline and after 3, 6 and 12 months. Additionally, both groups kept food diaries. The statistical data processing was performed variance analysis of using the Friedman test (significant differences were at p ≤ 0.05).Results. The year of observation in preschool children showed that two 3-month courses of an S. salivarius M18 probiotic intake led to a signifcant improvement in the hygiene index by 2.2 times, 2.3-fold stabilization of initial caries according to the ICDAS II index, caries decrease by 81%, gingivitis prevalence reduction (PMA index decrease by 72.9%).Conclusion. The study results confirm the effectiveness of S. salivarius M18 probiotic in preschoolers with caries as a means of dental status correction and stabilization.

Efficacy of Scalp Acupuncture in Patients With Post-stroke Hemiparesis: Meta-Analysis of Randomized Controlled Trials.

Objectives: To conduct a meta-analysis to assess the efficacy of scalp acupuncture (SA) in patients with stroke and consequent hemiparesis regardless of brain infarction or intracerebral hemorrhage.Methods: A literature search of randomized controlled trials (RCTs) on SA for stroke was performed in five databases up to May 10, 2021. We investigated three types of outcome: motor function, sequelae of poststroke hemiparesis, and adverse effects. Methodological quality was assessed using the revised Cochrane risk of bias tool version 2.0.Results: Of 1,063 papers, 30 RCTs involving Fugl–Meyer Assessment were selected, among which 10 and four RCTs were selected for evaluation of courses lasting of 1 and 3 months, respectively. The meta-analysis of 1- and 3-month courses revealed significant differences in the motor function of the SA plus Western standard treatment group vs. Western standard treatment only (medication plus rehabilitation; P < 0.001). A 3-month course tended to result in better outcomes than a 1-month course.Conclusions: Our meta-analysis results reveal that SA improves motor function in patients with acute to chronic stroke, regardless of brain infarction or intracerebral hemorrhage. However, because of a lack of methodological quality, thoroughly planned clinical studies are still required.

Enhancing Bioinformatics and Genomics Courses: Building Capacity and Skills via Lab Meeting Activities: Fostering a Culture of Critical Capacities to Read, Write, Communicate and Engage in Rigorous Scientific Exchanges.

Reading, writing, publishing, and publicly presenting scientific works are vital for a young researcher's profile building and career development. Generally, the traditional educational curricula do not offer training possibilities to learn and practice how to prepare, write, and present scientific works. These are rather a part of lab meeting activities in research groups. The lack of such training is more critical in some developing countries because this adds to the rare opportunities to discuss and become involved in the exchanges on state of the art scientific literature. Here the authors relate their experience in introducing a weekly 1-day lab meeting in the framework of two previously organized 3-month courses on "Bioinformatics and Genome Analyses". The main activities which are developed during these lab meetings include scientific literature follow up as well as preparing and presenting oral and written scientific reviews. These activities prove to be useful for a student's self-confidence building, for enhancing their active participation during the lectures and practical sessions, as well as for the positive impact on running the whole course program. Incorporation of such lab meeting activities in the course program significantly improves the capacity building of the participants, their analytical and critical reading of scientific literature, as well as communication skills. In this work it is shown how to proceed with the different steps involved in the implementation of lab meeting activities, and to recommend their regular institution in similar courses.

Liver function, tolerability and satisfaction during treatment with ulipristal acetate in women with fibroids: a single center experience

The aim of the study was to evaluate liver function in women treated with ulipristal acetate (UPA) and to assess the tolerability and satisfaction during treatment. This Cross-sectional study included women with symptomatic uterine fibroids subjected to one or more 3-month treatment courses of 5 mg UPA daily. Following European Medical Agency’s prescriptions, women were asked about symptoms potentially related to liver damage and had blood tests done, to assess serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Data on side effects, tolerability and satisfaction with the therapy were obtained during a phone interview. A total of 162 women completed the study with a mean treatment duration of 1.8 ± 0.9 cycles. No increased AST and ALT serum levels were detected and no woman reported symptoms suggestive of liver injury. The majority of women reported improvement of fibroids-related symptoms and a high degree of satisfaction with treatment. More than half of women had side effects, in most cases not as severe as to discontinue therapy. Ulipristal acetate did not worsen liver function or cause severe organ injury and showed high tolerability and satisfaction profiles. Therefore, we believe that it can still be considered a valuable option in the treatment of uterine fibroids.

Treating Langerhans cell histiocytosis, globally.

Treating Langerhans cell histiocytosis, globally.

Matrix Metalloproteinase Activity Correlates With Uterine Myoma Volume Reduction After Ulipristal Acetate Treatment.

Ulipristal acetate (UPA), a selective progesterone receptor modulator, clinically reduces uterine myoma size in 80% of cases. However, the molecular mechanism of action is still poorly understood, as is the reason why 20% of myomas do not respond to treatment. To elucidate whether matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) are associated with myoma volume shrinkage after UPA therapy. Prospective study. Academic research unit of a university hospital. Uterine biopsies were obtained from 59 patients with symptomatic myomas undergoing myomectomy, 45 of whom were treated preoperatively with either one or greater than or equal to two, 3-month courses of UPA and 14 not given any hormone therapy to serve as controls. Myoma volume was individually monitored during UPA therapy to determine any substantial clinical response (defined as a reduction in volume of >25%). Three groups were established based on the response to treatment: responsive (R) after one course (n = 12); R after two to four courses (n = 15); and nonresponsive (NR; n = 18). UPA treatment given as preoperative management for symptomatic myomas. MMP and TIMP expression assessed by zymography and immunohistochemistry. Compared with controls and NR myomas, responders showed significantly higher expression levels for MMP-1 (P < 0.0001) and MMP-2 (P = 0.009) and significantly lower expression levels for TIMP-1 (P = 0.040). The correlation found between MMP expression and volume fold change supports the notion that MMPs play a key role in UPA-induced myoma shrinkage.

Safety after extended repeated use of ulipristal acetate for uterine fibroids.

ObjectiveTo assess long term safety of extended repeated 3-month courses of ulipristal acetate (UPA) 10 mg/day, for up to 8 courses, with focus on endometrial and laboratory safety parameters.MethodsThis long-term, multi-center, open-label cohort, follow up study consisted of up to 8 consecutive 3-month courses of daily UPA 10 mg, each separated by a drug free period of 2 spontaneous menstrual bleeds. Sixty-four pre-menopausal women, with moderate to severe symptomatic uterine myoma(s) and heavy bleeding were enrolled and were studied for approximately 4 years. The main outcome measures were endometrial histology, laboratory parameters and general safety.ResultsAll data was reported in a descriptive manner with no formal statistical comparisons. In the 64 women, non-physiological changes (mostly cyst formation, epithelial and vascular changes) in endometrial histology at screening and after treatment courses 4 and 8 were observed in 18.0%, 21.4% and 16.3% of biopsies, respectively. After treatment cessation, such changes were observed in 9.1% of biopsies. All endometrial biopsies were benign after course 8. The median endometrial thickness was 7.0 mm, 10–18 days after the start of menses following treatment courses 5–8, compared to 9.0 mm at screening (before UPA treatment). No changes in the number and type of laboratory results outside the normal ranges were observed with the increasing treatment courses. In total, adverse events were reported in 10 (16%), 12 (19%), 8 (14%) and 5 (9%) subjects, during treatment courses 5, 6, 7 and 8, respectively of which the most frequent adverse events were headache and hot flush.ConclusionThe results of this study further support the safety profile of extended repeated 3 months treatment of symptomatic fibroids with ulipristal acetate 10 mg/day. Repeated UPA treatment courses did not result in any changes of concern in endometrial histology, endometrial thickness, or laboratory safety measures.

Teaching Staff Advanced Training in Russia, the Republic of Kazakhstan, the USA and Canada

Abstract In the article the peculiarities in organization of postgraduate teacher training in foreign countries have been highlighted; the basic problems and prospects for advanced training which stipulate for reforming the relevant national systems have been revealed; common and distinctive trends in their development have been justified. In Russia there is a cascade (cyclic) system of teaching staff advanced training, based on the principles of andragogy, namely, continuity, self-control and self-analysis of professional activities by teachers and the use of their own experience during the advanced training. The abovementioned system consists of three phases such as pre-course, course and implementing. Each element of this model is a constituent part of the other, providing cycling and growth. Tasks for teachers are grounded on all the phases of the described system and influence their professional development. In the Republic of Kazakhstan there are three basic systems for teaching staff advanced training, namely, centers of educational excellence at the “Nazarbayev Intellectual Schools”, JSC “National Centre of Teaching Staff Advanced Training” (based on RIPKSO and 16 regional teaching staff advanced training institutes), teaching staff advanced training centres at universities and experimental sections. According to the defined module in the terms of the complex 3-month courses combining face-to-face and online training are provided. In the USA advanced training is provided by multilevel higher educational institutions which offer a wide range of different full-time and distance training programs and some programs are taught directly in educational establishments. The content of advanced training is determined by standards of professional pedagogical education according to the educational program and provides for fundamental, psychological, pedagogical, methodical, IT, practical, social and humanitarian training. Teaching staff advanced training in Canada is provided by various educational establishments, departments of education, school boards, regional centers of education, teachers unions and private providers of professional development services.

Long-term treatment of uterine fibroids with ulipristal acetate☆

To investigate the efficacy and safety of ulipristal acetate (UPA) for long-term treatment of symptomatic uterine fibroids. Repeated intermittent open-label UPA courses, each followed by randomized double-blind norethisterone acetate (NETA) or placebo. European clinical gynecology centers. Two hundred and nine women with symptomatic fibroids including heavy menstrual bleeding. Patients received up to four 3-month courses of UPA 10 mg daily, immediately followed by 10-day double-blind treatment with NETA (10 mg daily) or placebo. Amenorrhea, fibroid volume, endometrial histology. After the first UPA course, amenorrhea occurred in 79% of women, with median onset (from treatment start) of 4 days (interquartile range, 2-6 days). Median fibroid volume change was -45% (interquartile range, -66%; -25%). Amenorrhea rates were 89%, 88%, and 90% for the 131, 119, and 107 women who received treatment courses 2, 3, and 4, respectively. Median times to amenorrhea were 2, 3, and 3 days for treatment courses 2, 3, and 4, respectively. Median fibroid volume changes from baseline were -63%, -67%, and -72% after treatment courses 2, 3, and 4, respectively. All endometrial biopsies showed benign histology without hyperplasia; NETA did not affect fibroid volume or endometrial histology. Repeated 3-month UPA courses effectively control bleeding and shrink fibroids in patients with symptomatic fibroids. ClinicalTrials.gov (www.clinicaltrials.gov) registration numbers NCT01156857 (PEARL III) and NCT01252069 (PEARL III extension).

Postmenopausal women treated with combination parathyroid hormone (1–84) and ibandronate demonstrate different microstructural changes at the radius vs. tibia: the PTH and Ibandronate Combination Study (PICS)

In postmenopausal women receiving combination parathyroid hormone (PTH) (1-84) therapy and ibandronate, we evaluated bone microarchitecture and biomechanics using high-resolution peripheral quantitative computed tomography (HR-pQCT). Cortical and trabecular changes were different at the nonweight-bearing radius vs. the weight-bearing tibia, with more favorable overall changes at the tibia. PTH therapy and bisphosphonates decrease fracture risk in postmenopausal osteoporosis, but their effects on bone microstructure and strength have not been fully characterized, particularly during combination therapy. PTH increases trabecular bone mineral density (BMD) substantially but may decrease cortical BMD, possibly by stimulating intracortical remodeling. We evaluated bone microarchitecture and biomechanics with HR-pQCT at the radius (a nonweight-bearing site) and tibia (weight bearing) in women receiving combination PTH(1-84) and ibandronate. Postmenopausal women with low bone mass (n = 43) were treated with 6 months of PTH(1-84) (100 μg/day), either as one 6- or two 3-month courses, in combination with ibandronate (150 mg/month) over 2 years. HR-pQCT was performed before and after therapy. Because changes in HR-pQCT parameters did not differ between treatment arms, groups were pooled into one cohort for analysis. Trabecular BMD increased at both radius and tibia (p < 0.01 for each). Cortical thickness and BMD decreased at the radius (p < 0.01), consistent with changes in dual-energy X-ray absorptiometry, while these parameters did not change at the tibia (p ≤ 0.02 for difference between radius and tibia). In contrast, cortical porosity increased at the tibia (p < 0.01) but not radius. Stiffness and failure load decreased at the radius (p < 0.0001) but did not change at the tibia. Cortical and trabecular changes in response to the PTH/ibandronate treatment combinations utilized in this study were different at the nonweight-bearing radius vs. the weight-bearing tibia, with more favorable overall changes at the tibia. Our findings support the possibility that weight bearing may optimize the effects of osteoporosis therapy.

Rilonacept for Colchicine-Resistant or -Intolerant Familial Mediterranean Fever

Currently, there is no proven alternative therapy for patients with familial Mediterranean fever (FMF) that is resistant to or intolerant of colchicine. Interleukin-1 is a key proinflammatory cytokine in FMF. To assess the efficacy and safety of rilonacept, an interleukin-1 decoy receptor, in treating patients with colchicine-resistant or -intolerant FMF. Randomized, double-blind, single-participant alternating treatment study. (ClinicalTrials.gov number: NCT00582907). 6 U.S. sites. Patients with FMF aged 4 years or older with 1 or more attacks per month. One of 4 treatment sequences that each included two 3-month courses of rilonacept, 2.2 mg/kg (maximum, 160 mg) by weekly subcutaneous injection, and two 3-month courses of placebo. Differences in the frequency of FMF attacks and adverse events between rilonacept and placebo. 8 males and 6 females with a mean age of 24.4 years (SD, 11.8) were randomly assigned. Among 12 participants who completed 2 or more treatment courses, the rilonacept-placebo attack risk ratio was 0.59 (SD, 0.12) (equal-tail 95% credible interval, 0.39 to 0.85). The median number of attacks per month was 0.77 (0.18 and 1.20 attacks in the first and third quartiles, respectively) with rilonacept versus 2.00 (0.90 and 2.40, respectively) with placebo (median difference, -1.74 [95% CI, -3.4 to -0.1]; P = 0.027). There were more treatment courses of rilonacept without attacks (29% vs. 0%; P = 0.004) and with a decrease in attacks of greater than 50% compared with the baseline rate during screening (75% vs. 35%; P = 0.006) than with placebo. However, the duration of attacks did not differ between placebo and rilonacept (median difference, 1.2 days [-0.5 and 2.4 days in the first and third quartiles, respectively]; P = 0.32). Injection site reactions were more frequent with rilonacept (median difference, 0 events per patient treatment month [medians of -4 and 0 in the first and third quartiles, respectively]; P = 0.047), but no differences were seen in other adverse events. Small sample size, heterogeneity of FMF mutations, age, and participant indication (colchicine resistance or intolerance) were study limitations. Rilonacept reduces the frequency of FMF attacks and seems to be a treatment option for patients with colchicine-resistant or -intolerant FMF. U.S. Food and Drug Administration, Office of Orphan Products Development.

Pharmacokinetic evaluation of ulipristal acetate for uterine leiomyoma treatment

Introduction: Progesterone (P), and its receptors (PRs), play a key role in uterine leiomyoma growth. Selective progesterone receptor modulators exert mixed antagonist and agonist effects on the PRs. Mifepristone, a PR-antagonist, reduces leiomyoma volume and related symptoms. Ulipristal acetate (UPA) exerts a potent antiprogestin activity, with less antiglucocorticoid activity compared to mifepristone. This property provides potential advantages for long-term use.Areas covered: This paper focuses on the effect of UPA on leiomyoma's growth and related symptoms in women. The authors also evaluate UPA's efficacy in reducing leiomyoma's size and menorrhagia in Phase II/III trials.Expert opinion: In the authors' opinion, UPA (5 mg/day) over 3 months can be used to plan the surgery in women with symptomatic leiomyomas. The tolerability and the safety of treatment over a period longer than 3 months have to be evaluated. The results of the follow-up treatment suggest that further studies could successfully evaluate the efficacy and the tolerability of intermittent 3-month courses of treatment.

Effects of the Ganning Formula ( ) on Liver Fibrosis in Patients With Chronic Hepatitis B

To investigate the clinical efficacy and safety of the Ganning formula for the treatment of liver fibrosis in patients with chronic hepatitis B. In a multicenter, randomized, controlled clinical trial, 150 patients with liver fibrosis secondary to hepatitis B virus (HBV) infection were randomly assigned in equal numbers to receive either the Ganning formula (a Chinese herbal decoction; active treatment group) or oral entecavir (control group) for two 3-month courses. Patients were monitored for any treatment-induced changes in liver function test parameters (ALT, AST, and GGT), liver fibrosis markers (LN, HA, IV-C, and PCIII), HBV DNA level, hepatosplenic imaging, quality of life scores, or psychological and social functioning scores. Patients were also observed for any adverse effects. After treatment, patients in both groups experienced significant improvements in liver function, HBV DNA load, hepatosplenic B-mode ultrasonography, quality of life, and psychological and social functioning (P < 0.05 or P < 0.01). Patients receiving the Ganning formula achieved greater improvements in HA, IV-C, quality of life, and psychological and social functioning compared with those on entecavir (P < 0.05 or P < 0.01). There were no abnormal changes in blood tests, urine, feces, renal function, or electrocardiogram. Additionally, no adverse effects were observed in any patients in either group. The Ganning formula appears to have the potential to inhibit liver fibrosis and therefore improve liver function by inhibiting HBV replication in patients with chronic hepatitis B. Additionally, this formula is helpful in improving quality of life and psychological and social functioning.

Rilonacept (IL-1 TRAP) for treatment of colchicine resistant familial mediterranean fever (FMF): a randomized, multicenter double-blinded, alternating treatment trial

Methods Subjects were FMF patients ≥4 years of age recruited at 6 U.S. sites, who had at least 1 FMF attack per month despite receiving adequate doses of, or who were intolerant of colchicine. Subjects received two 3-month courses of rilonacept (Arm A) at 2.2 mg/kg (max 160 mg) by weekly SC injection and two 3-month courses of placebo (Arm B). Patients were randomized to 1 of 4 treatment sequences (ABAB, BABA, ABBA, BAAB). Escape visits were allowed to permit switching arms (blinding was maintained) for patients with at least 2 attacks within a course. The primary outcome was the difference of FMF attacks between rilonacept and placebo courses with responders defined as subjects with a >40% difference. Results were analyzed by paired t-and signed rank tests. Results Fourteen subjects were randomized, 8 males and 6 females, mean (±SD) age 24.4±11.8 years (range 4.547.3; 4 patients <18 years), disease duration 17.5±12.6 yrs, with a baseline of 3.1±2.0 attacks per month. Eleven completed the full study and 3 dropped out (1 due to lack of efficacy, 1 due to distance from study site and 1 lost to follow-up). Among 12 patients who completed at least 2 treatment courses the mean number of attacks per month on rilonacept was 1.0±1.2 vs. 1.8±0.9 on placebo (P=0.021 by paired t-test and 0.027 by signed rank test). There were 8 responders; all 4 non-responders were adults. There were 2 respiratory infection SAEs, 1 on rilonacept and 1 on placebo. Injections site reactions were significantly more frequent with rilonacept but no differences were seen in other adverse events, including infections.

Longterm experience of magnerot administration in patients with mitral valve prolapse

Within 15 years observation 31 patients with prolaps the mitral valve, regularly accepting magnerot, in a dose of 1500 mg a day during all period of observation by 3-month's courses 2 times a year was spent. Features of dynamics of a clinical picture, their interrelation with phenotypic expression of a dysplasia of a connecting tissue, changes of an electrocardiogram, a structure of the valves apparatus of heart, a condition of a vegetative homeostasis, change of level and a daily profile of arterial pressure, a tonus of sympathetic and parasympathetic departments of vegetative nervous system are taped. Against treatment according to the retrospective analysis significant improvement of clinic-tool indicators at all surveyed patients isn't. After regular application of magnesium salt orotate acids authentic improvement of quality of life at patients with prolepses the mitral valve is established.

Pronect: A multiprofessional training course in the care of the AMI

The acute myocardial infarction (AMI) recognition and treatment (PRONECT™) course is a 1-day (3 h) course originally designed to give doctors greater confidence and ability in the recognition and management of adult patients who have AMI. It may also be suitable for many other groups of health professionals. PRONECT™ was developed using principles common to many advanced life support courses and incorporates aspects of clinical governance, multidisciplinary education and interprofessional working. It incorporates precourse reading, informal and interactive seminars, and role-play during three clinically based scenarios. A novel aspect of PRONECT™ is that participants undertake role interchange during scenarios, thereby facilitating mutual understanding. At all times during the course, participants are encouraged to reflect on their actions and to pay particular attention to detail. Using an initial and final theoretical written test, after the 3-month courses (36 courses), we assessed the knowledge of aspects of AMI among 900 doctors. The average (±standard deviation) knowledge score was higher for those who had completed an PRONECT™ course, pre-test (545 students) = 23.8 (8.44 ± 1.30) points and post-test (834 students) = 25.3 (9.85 ± 2.12) points (P < 0.05). In addition, those in the post-PRONECT™ group also showed significantly better knowledge about AMI (85.6% [714 doctors]) acquired skills in treatment an AMI. We have demonstrated evidence that doctors knowledge of AMI can be improved by attending courses, such as PRONECT™.

PRONECT: a multiprofessional training course in the care of the acute myocardial infarction

The Acute Myocardial Infarction (AMI) Recognition and Treatment (PRONECT™) course is a 1-day (3-hour) course originally designed to give doctors greater confidence and ability in the recognition and management of adult patients who have AMI. It may also be suitable for many other groups of health professionals. PRONECT™ was developed using principles common to many advanced life support courses and incorporates aspects of clinical governance, multidisciplinary education and interprofessional working. It incorporates precourse reading, informal and interactive seminars, and role-play during three clinically based scenarios. A novel aspect of PRONECT™ is that participants undertake role interchange during scenarios, thereby facilitating mutual understanding. At all times during the course, participants are encouraged to reflect on their actions and to pay particular attention to detail. Using initial and final theoretical written tests, after the 3-month courses (36 courses), we assessed the knowledge of aspects of AMI among 900 doctors. The average (± SD) knowledge score was higher for those who had completed a PRONECT™ course, pre-test (545 students) = 23.8 (8.44 ± 1.30) points and post-test (834 students) = 25.3 (9.85 ± 2.12) points (P < 0.05). In addition, those in the post-PRONECT™ group also showed significantly better knowledge about AMI (85.6% [714 doctors]) and acquired skills in treatment an AMI. We have demonstrated evidence that doctors' knowledge of AMI can be improved by attending courses such as PRONECT™.

EMERGE™: a multiprofessional training course in the care of the acute coronary syndrome patient

The Acute Coronary Syndrome (ACS) Recognition and Treatment (EMERGE™) course is a 1-day (3 hours) course originally designed to give doctors greater confidence and ability in the recognition and management of adult patients who have ACS. It may also be suitable for many other groups of health professionals. EMERGE™ was developed using principles common to many advanced life support courses and incorporates aspects of clinical governance, multidisciplinary education and interprofessional working. It incorporates precourse reading, informal and interactive seminars, and role-play during three clinically based scenarios. A novel aspect of EMERGE™ is that participants undertake role interchange during scenarios, thereby facilitating mutual understanding. At all times during the course, participants are encouraged to reflect on their actions and to pay particular attention to detail. Using initial and final theoretical written test, after the 3-month courses (36 courses), we assessed the knowledge of aspects of ACS among 900 doctors. The average (± standard deviation) knowledge score was higher for those who had completed an EMERGE™ course, pre-test (545 students) = 23.8 (8.44 ± 1.30) points and post-test (834 alunos) = 25.3 (9.85 ± 2.12) points (P < 0.05). In addition, those in the post-EMERGE™ group also showed significantly better knowledge about ACS (85.6% [714 doctors]) acquired skills in treatment an ACS. We have demonstrated evidence that doctors' knowledge of ACS can be improved by attending courses such as EMERGE™.

Improvement of pagetic bone lesions with risedronate treatment: a radiologic study

Risedronate is a potent pyridinyl bisphosphonate in clinical development for treatment and prevention of osteoporosis, and has been recently approved for treatment of Paget’s disease in the United States. An open-label study was conducted to determine the effect of risedronate treatment on pagetic bone lesions in patients with moderate to severe Paget’s disease (mean serum alkaline phosphatase levels [ALP] approximately seven times the upper limit of normal). Patients were treated with 30 mg/day oral risedronate for 84 days followed by a 112-day nontreatment period. This 196-day cycle was repeated once in patients whose ALP did not normalize or who experienced relapse, defined as a ≥25% increase in ALP from the lowest value measured. Radiographs of affected anatomical sites in 26 patients were collected at baseline, 6 months, and/or 12 months. Eleven patients received one course and 15 patients received two courses of treatment. Radiographs were examined by a skeletal radiologist who was blinded to their time sequence. Changes in pagetic lesions were categorized as “improved,” “deteriorated,” or “no change.” Between baseline and 6 months, 16 patients improved and 3 deteriorated; at 12 months, 11 patients improved and 2 deteriorated. Most lesions remained unchanged between 6 and 12 months. Improvements were noted in all skeletal sites (tibia, femur, humerus, forearm, pelvis, spine, and skull), but were most pronounced in weight-bearing long bones. In weight-bearing bones, nine lesions had osteolytic fronts. Of these, seven improved and two remained unchanged at 6 months; at 12 months, all but one lesion (which improved) remained unchanged. This radiographic assessment demonstrates that oral risedronate, 30 mg/day in one or two 3-month courses, is highly effective for improving bone lesions in patients with Paget’s disease. Risedronate treatment had no deleterious effect on osteolytic lesions in weight-bearing bones; indeed, the majority of lesions with osteolytic fronts were improved after 6 months of risedronate treatment.