Adapted cardiac rehabilitation for people with sub-acute, mild-to-moderate stroke: a mixed methods feasibility study.

OBJECTIVE: To determine the recruitment strategy, acceptability, adherence, outcome measures, and adverse events for a definitive study that will explore adapted cardiac rehabilitation (CR) for people post-stroke with mild-to-moderate severity stroke in the sub-acute stage of recovery. DESIGN: Mixed methods feasibility study. SETTING: Acute hospital setting, neurology outpatients and community hospitals. PARTICIPANTS: 32 participants with stroke (mean age: 64.4 years) of median National Institutes of Health Stroke Scale (NIHSS) score 2 (range: 0 to 6) within six months of stroke. INTERVENTION: All participants attended six weeks, adapted CR within one to six months after a stroke. A combined class with people post cardiac event. MAIN OUTCOME MEASURES: Incremental shuttle walk test (ISWT), blood pressure, heart rate, weight, body mass index, quality of life, fatigue, anxiety and depression, tone, falls, stroke attitude and knowledge, physical activity (accelerometry) and functional ability. QUALITATIVE: Interviews with participants, non-participants and people post-cardiac event. Focus groups with Stroke and CR teams. RESULTS: 32 participants were recruited. The programme was acceptable to people with mild stroke (NIHSS<3) and people post cardiac events; 80% of classes attended, a mean of 9.6 classes, with six drop-outs. The ISWT was an acceptable outcome measure (for NIHSS<3) and most measures showed positive changes. There was one adverse event. CONCLUSION: A definitive study to determine the effect of six weeks of adapted CR on cardiorespiratory fitness (CRf) in people who have had a mild severity stroke (NIHSS<3) in the sub-acute phase of recovery, is feasible. Teams need specialist education and support. A more specialist service may be needed for people with a stroke severity defined by NIHSS>2. CLINICAL TRIAL REGISTRATION NUMBER: ISRCTN14861846.

AIDS: MetLife's experience.

The national health burden created by AIDS/HIV disease has had a significant impact on the insurance industry. In an analysis of the MetLife health and life insurance claims from 1986 through 1989, it was found that a total of $323,900,000 has been paid for AIDS/HIV disease. This figure and related information from those years were based on the Company's underwriting and claims files, with personal and group operations reported separately. Personal life insurance claims rose from 344 in 1986 to 874 in 1989 with the dollar amounts increasing from $3.2 million to $8.9 million. In 1989 there were 689 group life claims with a face amount of $31.5 million and 6,450 people who received group medical claim payments for a total of $111.2 million. In 1989 AIDS claims comprised 1.61 percent of MetLife claims--up from 0.4 percent in 1986.

Cost-effective curriculum planning in health education.

Given the rigorous demands of regulatory agencies and the funding cutbacks prevalent in current educational institutions, educators must find new ways to incorporate modern advances in their respective fields into already overcrowded curricula. This article describes a major problem facing educators today, outlines various methods that have been used (for the most part, unsatisfactorily) to solve the dilemma, and posits a systematic approach to modern curriculum planning that has been field tested at the Kettering Medical Center School of Medical Technology. By way of illustration of this process, the authors include data gathered during development of the cost-effective curriculum planning approach. While the method described in this article has been expressly designed for the allied health professions, its theory and recommendations may be generalized to virtually any field.

Development of professional competence via self-instructional units.

In recent years, self-instructional teaching methods have come under criticism from educators, much of it warranted. But when self-instructional materials are written by experienced educators who teach the topic and are developed within a versatile process using a proven format, they are extremely valuable teaching aids. We discuss here the results of a grant project funded by W. K. Kellogg Foundation and describe the process used at Kettering Medical Center's School of Medical Technology to develop and produce over 100 self-instructional units. We also discuss potential uses of self-instructional units in professional continuing education programs and suggest ways self-instructional units might be used to promote interdisciplinary health care and expansion of professional knowledge banks. This project confirmed that professions can create their own educational materials through the independent efforts of their members.

Crescentic light-chain glomerulopathy. Report of a case.

Light-chain glomerulopathy occurred in a middle-aged woman with adult-onset diabetes mellitus and IgG-kappa light-chain multiple myeloma. Unusual features of the glomerulopathy included the presence of numerous epithelial crescents and rapid progression to chronic renal failure. The aggressiveness of her disease may be related to her underlying diabetes mellitus and associated abnormalities in glomerular clearance of macromolecules, including immunoglobulin light chains.