A community intervention study on patients' resuscitation and defibrillation quality after embedded training in a cardiac rehabilitation program.

The aim of this study was to examine the effectiveness of a novel cardiopulmonary resuscitation (CPR) training method embedded in a cardiac rehabilitation program at enhancing patients' CPR and defibrillation skills. One hundred and fourteen participants with coronary heart disease enrolled on an exercise-based cardiac rehabilitation program were included. Two groups were randomly allocated to different training programs: CPR-retraining based on hands-on rolling refreshers during the 2-month program (G-CPR, n = 53) versus standard one-time training (G-Stan, n = 61). Resuscitation and defibrillation skills and self-confidence were evaluated at baseline, following brief basic life support (BLS) instruction and after the distinct training programs. Baseline skills were equally poor, improving significantly although irregularly after brief instruction. After the program, CPR quality was further enhanced in G-CPR, which achieved better results regarding correct compressions by depth, rate, hands position and global CPR quality (P < 0.01, all analysis). Defibrillation skills improved similarly after instruction and were reasonably maintained after the program, although delay to shock was reduced in G-CPR. CPR self-confidence was superior in G-CPR (P < 0.001). In conclusion, CPR hands-on rolling refreshers embedded into an exercise-based cardiac rehabilitation program enhanced patients' CPR and defibrillation skills and self-confidence to perform CPR at 2 months, compared with standard one-time training. This method could help to bring effective training to high-risk populations.

The effectiveness of wet wrap dressings using 0.1% mometasone furoate and 0.005% fluticasone proprionate ointments in the treatment of moderate to severe atopic dermatitis in children.

Various types of dressings have been used successfully in the treatment of atopic dermatitis. In this study we looked at the efficacy of two of the newer topical steroids when applied under wet wrap dressings for the treatment of refractory atopic dermatitis in children. Forty children with moderate to severe disease were randomized to receive either one-tenth-strength diluted 0.1% mometasone furoate ointment or one-tenth-strength diluted 0.005% fluticasone proprionate ointment. These were applied once a day over a 4-week period without wet wraps, or for 2 weeks without wet wraps followed by 2 weeks of application under wet wraps. There was a 2-week period for all patients when the topical treatment was standardized. At weekly follow-ups, patients were assessed by a single, blinded observer and objectively scored for disease extent and severity. A subjective score was also given for the impact of eczema on daily living. There was significant improvement in the disease severity from baseline during the first 2 weeks of the open application arm (p=0.043), however, additional beneficial effects were limited after week 2. Wet wraps further improved the disease severity and extent after week 2 (p < 0.05), and were well tolerated. We concluded that both 0.1% mometasone furoate and 0.005% fluticasone proprionate ointments are effective in the treatment of atopic dermatitis, and that wet wraps are useful in further improving refractory disease in children.

Montelukast in the treatment of children with moderate-to-severe atopic dermatitis: a pilot study.

The primary action of leukotrienes includes contraction of human airway muscle, chemotaxis, and increased vascular permeability, with secondary effects of inhibiting allergen-induced early and late responses. Although there is limited available information and research regarding leukotrienes in atopic dermatitis (AD), there is evidence to support their role in the pathogenesis of the disease. We conducted a pilot study to test the efficacy of montelukast, a cysteinyl-leukotriene-1 receptor antagonist, in 15 patients (6-16 years of age) with moderate-to-severe AD, using a randomized double-blind placebo-controlled crossover study. These patients had chronic moderate-to-severe AD, despite being on conventional therapy. They were randomized either to placebo for 4 weeks and then the study drug for 4 weeks, or vice versa. There was a 2-week run-in period for all participants before commencement of the study, and a 2-week washout before crossover. At enrollment and on each follow-up visit, every patient was assessed by a single observer and objectively scored for disease extent and severity. A subjective score was given for the impact of eczema on daily living. There was statistical improvement in patents on active treatment compared with placebo in the severity of AD (p < 0.05). Our findings suggest that leukotriene receptor antagonist as an adjunct treatment has an anti-inflammatory effect on moderate-to-severe AD. A larger trial is needed to ascertain its efficacy fully.

Validation of the Chinese translated version of ISAAC core questions for atopic eczema.

BACKGROUND: The International Study of Asthma and Allergies in Childhood (ISAAC) was designed to allow international comparison of epidemiological data on atopic conditions in childhood. In so doing, further aetiological information would be obtained that in turn would provide a framework for future studies. The global ISAAC results on the prevalence of atopic dermatitis indicated a 60-fold variation recorded in different countries. Such a degree of difference may be partially due to the translated questionnaires that were not validated in all of the involved countries. OBJECTIVE: To validate the Chinese version of the ISAAC core questions for atopic eczema. METHODS: One thousand nine hundred and twenty children aged between 3 and 5 were randomly recruited from 13 kindergartens in Hong Kong. Using a dermatologist's clinical examination as the gold standard, we validated the Chinese version of the ISAAC core questions for atopic eczema. The Youden's Indexes obtained in our study were compared with those obtained in the United Kingdom's validation study. RESULTS: The Youden's Indexes obtained in our study were significantly lower than those from the United Kingdom. The low scores were likely to be due to a reduction in the sensitivity of the Chinese questionnaire, which ranged from 23.5% to 70.6%. CONCLUSION: Our findings indicate that the translated questionnaire is less effective than the English version in assessing the prevalence of atopic eczema. The indication of a low prevalence of atopic eczema among the Chinese population reported in previous studies was at least partially due to problems with the translated questionnaire.

Effects of overlapping parametric resonances on the particle diffusion process.

The evolution of the beam distribution in a double-rf system with a phase modulation on either the primary or secondary rf cavity was measured. We find that the particle diffusion process obeys the Einstein relation if the phase space becomes globally chaotic. When dominant parametric resonances still exist in the phase space, particles stream along the separatrices of the dominant resonance, and the beam width exhibits characteristic oscillatory structure. The particle-tracking simulations for the double-rf system are employed to reveal the essential diffusion mechanism. Coherent octupolar motion has been observed in the bunch beam excitation. The evolution of the longitudinal phase space in the octupole mode is displayed.