OBJECTIVE:To assess the effectiveness of brief interventions in heavy drinkers by analyzing the outcome data and methodologic quality. DESIGN:(1) Qualitative analysis of randomized control trials (RCTs) using criteria from Chalmers' scoring system; (2) calculating and combining odds ratios (ORs) of RCTs using the One-Step (Peto) and the Mantel-Haenszel methods. STUDY SELECTION AND DATA ANALYSIS: A MEDLINE andPsycLIT search identified RCTs testing brief interventions in heavy alcohol drinkers. Brief interventions were less than 1 hour and incorporated simple motivational counseling techniques much like outpatient smoking cessation programs. By a single-reviewer, nonblinded format, eligible studies were selected for adult subjects, sample sizes greater than 30, a randomized control design, and incorporation of brief alcohol interventions. Methodologic quality was assessed using an established scoring system developed by Chalmers and colleagues. Outcome data were combined by the One-Step (Peto) method; confidence limits and 2 test for heterogeneity were calculated. RESULTS:Twelve RCTs met all inclusion criteria, with an average quality score of 0.49 ؎ 0.17. This was comparable to published average scores in other areas of research (0.42 ؎ 0.16). Outcome data from RCTs were pooled, and a combined OR was close to 2 (1.91; 95% confidence interval 1.61-2.27) in favor of brief alcohol interventions over no intervention. This was consistent across gender, intensity of intervention, type of clinical setting, and higher-quality clinical trials. CONCLUSIONS:Heavy drinkers who received a brief intervention were twice as likely to moderate their drinking 6 to 12 months after an intervention when compared with heavy drinkers who received no intervention. Brief intervention is a low-cost, effective preventive measure for heavy drinkers in outpatient settings. significant number of North Americans drink excessive amounts of alcohol. Although excessive alcohol use is often socially accepted behavior, there is a notable increased risk of workforce dysfunction, motor vehicle accidents, injuries, marital discord, family dysfunction, alcoholrelated disease, and death. 1 Average daily alcohol consumption above two or three drinks has been shown to result in subjective complaints, physical findings, alcoholrelated problems, and alcohol dependence. 2,3 These consequences of excessive alcohol use are seen in the primary care and hospital settings with prevalence rates approaching 20% to 40%. [4][5][6][7][8] Excessive drinking behavior, often described as problem drinking, heavy drinking, or at-risk drinking, is generally not associated with alcohol dependence such as major withdrawal symptoms, tolerance, complete loss of control, or preoccupation with drinking. 9 The definition of excessive or problem drinking is imprecise and often depends on not only quantity and frequency of alcohol consumed but also individual characteristics such as gender, age, weight, and comorbid conditions. 10 The Institute of Medicine reports that up to 20% of ...

Compared with placebo, there is a higher likelihood of experiencing several amiodarone-related adverse effects with exposure to low daily doses of the drug. Thus, although low dose amiodarone may be well tolerated, it is not free of adverse effects.

Prognostic significance of tumor histology and four computed tomography (CT) staging methods was tested retrospectively in dogs from three treatment centers that underwent intent-to-cure-radiotherapy for intranasal neoplasia. Disease-free and overall survival times were available for 94 dogs. A grouping of anaplastic, squamous cell, and undifferentiated carcinomas had a significantly shorter median disease-free survival (4.4 mo) than a grouping of all sarcomas (10.6 months). Disease-free survivals were not significantly different, when all carcinomas were compared with all sarcomas. The published original and modified WHO staging methods did not significantly relate to either survival endpoint. A modified human maxillary tumor staging system previously applied to canine nasal tumors was prognostically significant for both survival endpoints; a further modified version of that CT-based staging system resulted in improved significance for both survival endpoints. Dogs with unilateral intranasal involvement without bone destruction beyond the turbinates on CT, had longest median survival (23.4 months); CT evidence of cribriform plate involvement was associated with shortest median survival (6.7 months). Combining CT and histology statistically improved prognostic significance for both survival endpoints over the proposed CT staging method alone. Significance was lost when CT stages were collapsed to < four categories or histopathology groupings were collapsed to < three categories.

Purpose To compare the validity of various physical activity measures with doubly labeled water (DLW)–measured physical activity energy expenditure (PAEE) in free-living older adults. Methods Fifty-six adults aged ≥65 yr wore three activity monitors (New Lifestyles pedometer, ActiGraph accelerometer, and a SenseWear (SW) armband) during a 10-d free-living period and completed three different surveys (Yale Physical Activity Survey (YPAS), Community Health Activities Model Program for Seniors (CHAMPS), and a modified Physical Activity Scale for the Elderly (modPASE)). Total energy expenditure was measured using DLW, resting metabolic rate was measured with indirect calorimetry, the thermic effect of food was estimated, and from these, estimates of PAEE were calculated. The degree of linear association between the various measures and PAEE was assessed, as were differences in group PAEE, when estimable by a given measure. Results All three monitors were significantly correlated with PAEE (r = 0.48–0.60, P < 0.001). Of the questionnaires, only CHAMPS was significantly correlated with PAEE (r = 0.28, P = 0.04). Statistical comparison of the correlations suggested that the monitors were superior to YPAS and modPASE. Mean squared errors for all correlations were high, and the median PAEE from the different tools was significantly different from DLW for all but the YPAS and regression-estimated PAEE from the ActiGraph. Conclusions Objective devices more appropriately rank PAEE than self-reported instruments in older adults, but absolute estimates of PAEE are not accurate. Given the cost differential and ease of use, pedometers seem most useful in this population when ranking by physical activity level is adequate.