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TOM HURLEY, M.S.
Reiff-Hekking
S, Ockene JK, Hurley TG, Reed GW. Brief physician and nurse
practitioner-delivered counseling for high-risk drinking.
Results at 12-month follow-up. J Gen Intern Med. 2005
Jan;20(1):7-13.
The objective of this study was to
determine the effects of a brief primary care
provider-delivered counseling intervention on the reduction
of alcohol consumption by high-risk drinkers. The
intervention was implemented as part of routine primary care
medical practice. METHODS: We performed a controlled
clinical trial with 6- and 12-month follow-up. Three primary
care practices affiliated with an academic medical center
were randomly assigned to special intervention (SI) or usual
care (UC). A total of 9,772 primary care patients were
screened for high-risk drinking. A fourth site was added
later. From the group that was screened, 530 high-risk
drinkers entered into the study, with 447 providing
follow-up at 12 months. The intervention consisted of brief
(5-10 minute) patient-centered counseling plus an office
system that cued providers to intervene and provided patient
educational materials. RESULTS: At 12-month follow-up, after
controlling for baseline differences in alcohol consumption,
SI participants had significantly larger changes (P=.03) in
weekly alcohol intake compared to UC (SI=-5.7 drinks per
week; UC=-3.1 drinks per week), and of those who changed to
safe drinking at 6 months more SI participants maintained
that change at 12 months than UC. CONCLUSIONS: Project
Health provides evidence that screening and very brief (5-10
minute) advice and counseling delivered by a patient's
personal physician or nurse practitioner as a routine part
of a primary care visit can reduce alcohol consumption by
high-risk drinkers.
Gong Z, Xie D, Deng Z, Bostick RM,
Muga SJ, Hurley TG, Hebert JR. The PPAR{gamma} Pro12Ala
polymorphism and risk for incident sporadic colorectal
adenomas. Carcinogenesis. 2005 Mar;26(3):579-85. Epub 2004
Nov 25.
Peroxisome proliferator-activated
receptor gamma (PPARgamma), a member of the nuclear hormone
receptor superfamily initially shown to be a key regulator
of fat cell differentiation, can inhibit cell growth and
induce apoptosis in colon cell lines. There are heterozygous
loss of function mutations in the gene encoding PPARgamma in
tumors from approximately 10% of human colon cancer
patients. A common structural polymorphism has been detected
in the PPARgamma gene at codon 12 (Pro12Ala). We
investigated the hypothesis that the PPARgamma Pro12Ala
polymorphism is associated with colorectal adenoma risk in a
recently concluded case-control study of incident sporadic
colorectal adenomas (163 cases and 212 controls). The
multivariate-adjusted odds ratio (OR) for incident sporadic
colorectal adenoma was 0.65 (95% CI 0.39-1.09) for those
with the Pro12Ala or Ala12Ala genotype compared with those
with the Pro12Pro genotype. Multivariate-adjusted inverse
associations with the Ala12 variant were more pronounced
among those who were female (OR 0.36, 95% CI 0.18-0.75) or
did not take non-steroidal anti-inflammatory drugs (OR 0.38,
95% CI 0.14-1.00). Marginally significant results were
observed among those with a lower waist:hip ratio (OR 0.52,
95% CI 0.24-1.12) or a lower body mass index (OR 0.46, 95%
0.20-1.05). Smoking was a very strong risk factor (OR 2.34,
95%CI 1.37-4.02) for colorectal adenoma among those with the
wild-type (Pro12Ala) genotype, but not those with the Ala12
variant (OR 0.86, 95%CI 0.35-2.09). Larger studies are
needed to validate these results, which suggest that the
PPARgamma Pro12Ala polymorphism may interact with other
factors to protect against colorectal adenoma.
Heiney SP, McWayne J, Hurley TG, Lamb
LS Jr, Bryant LH, Butler W, Godder K. Efficacy of
therapeutic group by telephone for women with breast cancer.
Cancer Nurs. 2003 Dec;26(6):439-47.
A pilot study was conducted to test the
efficacy of a therapeutic group by telephone conference call
for women with breast cancer. Sixty-six women with stage I
or stage II breast cancer consented to participate in the
study. Participants were randomly assigned to a usual
psychosocial care or intervention group, using a permuted
block method. Only 2 of 68 patients dropped out of the
study, which included 27% African Americans. Assessments at
3 time periods (pretest, immediately after the intervention,
and 3 months after the group ended) included evaluation of
quality of life (QOL), mood, and immune function. ttests
were performed to determine if differences on important
variables existed at pretest. The intervention group had
worse QOL and mood scores than did the control group on the
pretests. A mixed-model repeated-measures procedure
controlling for pretest differences was used to analyze
data. A significant Group by Time interaction was found for
spiritual well-being and mood. These differences were not in
the expected direction. The intervention group showed
improvement in QOL and mood during the intervention, but
showed decompensation following the intervention.
Conversely, the control group demonstrated stable or
declining scores. This intervention is feasible and
practical for women with breast cancer, especially African
American participants. The puzzling results suggest several
areas for future research, including a better conceptual fit
with outcome measures, increasing dosage, and exploration of
the value of emotional expression.
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