Incidence of pressure ulcers in intensive care units and direct costs of treatment: Evidence from Iran

Background and objective

Pressure ulcer (PU) is one of the important and frequent complications of hospitalization, associated with high treatment costs. The present study was conducted to determine the incidence of PU and its direct treatment costs for patients in intensive care unit (ICU) in Iran.

Efficacy of Once-Daily Administration of Udenafil for 24 Weeks on Erectile Dysfunction: Results from a Randomized Multicenter Placebo-Controlled Clinical Trial

IntroductionThe method of administration of oral phosphodiesterase-5 inhibitors has been expanded to once-daily repeated administration with lower initial dosage than on-demand administration.AimThe aim of this study was to evaluate the efficacy and safety of once-daily udenafil as a treatment for erectile dysfunction (ED) for intermediate-term period.MethodsThis multicenter, randomized, double-blind clinical trial included 346 ED patients (placebo, udenafil 50 mg, udenafil 75 mg). Subjects were treated with each medication once daily for 24 weeks.Main Outcome MeasuresSubjects were asked to complete the International Index of Erectile Function (IIEF)-erectile function (EF) domain at baseline, 12 weeks, and 24 weeks and the development of adverse drug reactions (ADRs) was inspected.ResultsBoth dosages of udenafil induced a significant increase in IIEF-EF compared with placebo at both 12 and 24 weeks. When patients were divided according to the severity of baseline EF score, significant improvement was observed only with udenafil 75 mg regardless of the degree of ED. At 24 weeks, the proportions of patients who reported a return to normal EF (IIEF-EF over 26) were 39.1% for udenafil 50 mg and 47.0% for udenafil 75 mg. In terms of safety, ADRs were observed in 6.1%, 12.9%, and 17.9% for placebo, udenafil 50 mg, and 75 mg, respectively. Although a statistically higher rate of ADRs was observed in the udenafil 75 mg group (P = 0.024), the majority were mild and recovered without treatment.ConclusionsOnce-daily administration of udenafil 50 mg and 75 mg for 24 weeks resulted in improvement of EF. In particular, udenafil 75 mg improves EF regardless of the baseline degree of ED. Moon KH, Ko YH, Kim SW, Moon DG, Kim JJ, Park NC, Lee SW, Paick J-S, Ahn TY, Chung WS, Min KS, Park JK, Yang DY, and Park K. Efficacy of once-daily administration of udenafil for 24 weeks on erectile dysfunction: Results from a randomized multicenter placebo-controlled clinical trial. J Sex Med 2015;12:1194–1201.     

The expression of emotion through nonverbal behavior in medical visits

Relationship-centered care reflects both knowing and feeling: the knowledge that physician and patient bring from their respective domains of expertise, and the physician’s and patient’s experience, expression, and perception of emotions during the medical encounter. These processes are conveyed and reciprocated in the care process through verbal and nonverbal communication. We suggest that the emotional context of care is especially related to nonverbal communication and that emotion-related communication skills, including sending and receiving nonverbal messages and emotional self-awareness, are critical elements of high-quality care. Although nonverbal behavior has received far less study than other care processes, the current review argues that it holds significance for the therapeutic relationship and influences important outcomes including satisfaction, adherence, and clinical outcomes of care.     

What do you do for a living? Toward a more succinct definition of health services research

This commentary discusses the need for, and the advantages of, a more concise, revised definition of the field of health services research. It argues for a definition that includes not only the topics on which health services research focuses but also the goals of health services research. A number of condensed definitions are provided for consideration.     

Alveolar soft part sarcoma of the sphincter ani externus: Control of vaginal bleeding by recurrent embolisations

Alveolar soft part sarcoma is a rare malignancy mainly localized in the deep soft tissue of the extremities. This is the first report of an alveolar soft part sarcoma originating from the sphincter ani externus. A 27-year-old pregnant woman presented with a tumour located in the right ischiorectal fossa which had rapidly enlarged during pregnancy 6 years after first detection. Admitted to our hospital, she presented with a continuous strong vaginal bleeding, multiple pulmonal metastases and an inoperable local tumour mass. Palliative chemotherapy was unsuccessful, control of local bleeding was only possible with multiple embolisations. The patient died 43 months after initial diagnosis. Our intention is to point out the remarkable origin, a rapid tumour growth during pregnancy, and the possibility of controlling massive tumour bleeding by embolisation.     

Neuraxial blockade in children

Epidural blockade in children has become more popular for postoperative analgesia in recent years owing to increased experience, greater confidence and the development of appropriate equipment. In the UK, approximately 2000 lumbar epidural and continuous caudal blocks are performed each year. Spinal anaesthesia remains popular for babies at risk of postoperative apnoea, but is being superseded by light general anaesthesia with desflurane or sevoflurane combined with caudal blockade. Contraindications to neuraxial blockade include patient or parental refusal, coagulation abnormalities, septicaemia, raised intracranial pressure, meningitis, infection at the entry site, allergy to local anaesthetics, myelomeningocele (spina bifida) and abnormal sacral anatomy for a caudal epidural.     

Conventional versus digital radiographs for intraoperative cervical spine-level localization: a prospective time and cost analysis

BackgroundIn today's health-care environment, operational efficiency is intrinsic to balancing the need for increased productivity driven by rising costs and potentially decreasing reimbursement. Other operational factors kept constant, decreasing the time for a procedure can be viewed as one marker for increased efficiency.PurposeTo prospectively evaluate the time and operating room efficiency differences between the two methods for intraoperative level localization.Stydy designProspective nonrandomized study.Patient sampleProspective consecutive patients undergoing a single-level anterior cervical discectomy and fusion (ACDF) with plate and allograft.Outcomes measuresTime for performance and interpretation of intraoperative localization radiograph.MethodsThis is a prospective nonrandomized study of patients treated consecutively with a single-level ACDF with allograft and plating. All the patients underwent a conventional approach to the cervical spine. After exposure, a spinal needle was placed in the exposed intervertebral disc and a radiography was performed. Either a conventional or a digital radiography was used in each case.ResultsEighteen patients were enrolled in this study. Ten patients underwent localization with conventional radiography, whereas eight patients underwent localization with digital imaging. The mean time for conventional radiography was 823 seconds (standard deviation [SD], 159), and for digital, it was 100 seconds (SD, 34; p<.001).ConclusionsCurrent technology provides options for level localization. Digital imaging provides equally accurate information as conventional radiography in a significantly reduced amount of time. Image quality, ease or archival, and manipulation provided by digital radiography are superior to those by provided fluoroscopy. Keeping operational factors constant, decreasing the time for a procedure, and increasing the efficiency of the environment may be viewed as a surrogate for improving the cost basis for a procedure.