Health-related quality of life and pressure ulceration assessment in patients treated in the community

Little is known of the impact of pressure ulceration on adult patients' health-related quality of life. The purpose of this study was to determine the impact pressure ulceration has on pressure ulcer patients cared for in the community. A case control study design was used by drawing a random sample from patients receiving community nursing care, stratified by the presence of pressure ulceration. In all, 75 patients with pressure ulcers were compared with 100 controls without ulcers using the four-point ulcer grading scale described by United Kingdom consensus guidelines. Patients were interviewed using the Short Form-36 (SF-36) questionnaire and activities of daily living assessed using the modified Barthel scale. Patients with pressure ulcers had significantly poorer physical function (mean difference (d) = 37.6, 95% CI 28.6-46.6, p < 0.001) and social functioning (d = 33.9, 95 % CI 24.0-43.9, p < 0.001) than published age- and sex-matched normative data from the United Kingdom. The difference between cases and controls was much smaller in these domains, with neither approaching statistical significance. After adjustment for age and gender, scores for bodily pain were poorer in patients with no ulceration (d = -10.5, 95% CI - 20.6 to - 0.4, p = 0.042) indicating greater pain in these patients compared with the cases with ulceration. Activities of daily living determined by the modified Barthel scale showed reduced self-care (d = -7.6, 95% CI -12.5 to - 2.7, p = 0.010) and mobility (d = -9.2, 95% CI -14.6 to - 3.8, p = 0.001) in patients with pressure ulceration. The overall ability to perform these activities was also significantly poorer in this group (d = -16.3, 95% CI -27.3 to -5.3, p = 0.004). While patients with pressure ulceration experience some deficits in their health-related quality of life compared with a normal population, these differences are similar to those experienced by other patients receiving community nursing care.     

The Environmental Context of Patient Safety and Medical Errors

The environmental context of patient safety and medical errors was explored with specific interest in rural settings. Special attention was paid to unique features of rural: healthcare organizations and their environment that relate to the patient safety issue and medical errors (including the distribution of patients, types of adverse events associated with learning, information flows, triage and transfer decisions, and culture of safety). Relevant organizational theories and strategies fo medical error reduction and prevention in rural health care settings were identified. Financial and technical assistance are needed to support the systematic collection of data from rural hospitals and other entities and to enhance relevant patient safety practices for rural America.     

Role of DAT‐SPECT in the diagnostic work up of Parkinsonism

The diagnosis of idiopathic Parkinson's disease (PD) can be achieved with high degrees of accuracy in cases with full expression of classical clinical features. However, diagnostic uncertainty remains in early disease with subtle or ambiguous signs. Functional imaging has been suggested to increase the diagnostic yield in parkinsonian syndromes with uncertain clinical classification. Loss of striatal dopamine nerve terminal function, a hallmark of neurodegenerative Parkinsonism, is strongly related to decreases of dopamine transporter (DAT) density, which can be measured by single photon emission computed tomography (SPECT). The use of DAT‐SPECT facilitates the differential diagnosis in patients with isolated tremor symptoms not fulfilling PD or essential tremor criteria, drug‐induced, psychogenic and vascular Parkinsonism as well as dementia when associated with Parkinsonism. This review addresses the value of DAT‐SPECT in early differential diagnosis, and its potential as a screening tool for subjects at risk of developing PD as well as issues around the assessment of disease progression. © 2007 Movement Disorder Society     

In Vitro Wear of Nano-Composite Denture Teeth

PURPOSE: Few laboratory tests have been able to substantiate and quantify the wear resistances of polymeric denture teeth. This study evaluated the relative wear resistance of several types of denture teeth using an in vitro wear testing device. MATERIAL AND METHODS: Four different types of denture teeth [nano-filled (Veracia) and micro-filled composites (SR-Orthosit, Endura, Duradent, Surpass), cross-linked acrylic (SR-Postaris, Genios-P, Creapearl, Vitapan Physiodens, Premium 8, Integral), and a conventional acrylic (Biotone)] were used. The flattened buccal surface of each denture tooth was subjected to the evaluation of Knoop hardness (n=5) and localized wear for 100,000 cycles (n=10). Wear values were determined in micrometers using a profilometer. The data for the hardness, wear depth, and worn surface areas were individually analyzed by one-way ANOVA. RESULTS: Knoop hardness values (KHN) ranged from 28.2 to 29.8 for micro-filled composite, 18.9 to 21.6 for cross-linked acrylic, 22.7 for nano-composite, and 18.6 for conventional acrylic teeth. All micro-filled composite teeth were significantly harder than other teeth (p <0.0001). The wear depth values were 90.5 microm for the nano-composite, 69.8 to 93.0 microm for the micro-filled composite, 80.8 to 104.0 microm for the cross-linked acrylic, and 162.5 microm for conventional acrylic teeth. The worn surface areas were 5.1 mm2 for the nano-composite, 2.6 to 3.6 mm2 for the micro-filled composite, 4.4 to 5.7 mm2 for the cross-linked acrylic, and 10.1 mm2 for conventional acrylic teeth. The wear values of the acrylic control were significantly different from all other denture teeth (p <0.001). CONCLUSION: The nano-composite tooth was harder and more wear resistant than the acrylic teeth but not significantly different from most of the cross-linked and micro-filled composite teeth tested.     

Additives to increase tissue spread of local anesthetics

Certain drugs or chemicals may be added to local anesthetic solutions to enhance the tissue spread of the local anesthetic. Perhaps the best known is glucose (dextrose) added to spinal anesthesia solution to make it hyperbaric and to allow the local anesthetic to spread in the cerebrospinal fluid by gravity, as needed. Hyaluronidase addition has been abandoned in almost all other regional anesthetic blocks except ophthalmologic blocks. Hylauronidase is expensive and it is not devoid of side-effects and, therefore, as low concentrations as possible are recommended. Even as low concentration as 3.75 IU/mL of hyaluronidase is able to enhance the spread of the concentrated local anesthetic solution, causing analgesia and akinesia without damage to the eye muscles. Hyaluronidase addition to local anesthetic solutions is used to some extent also in dermatological surgery. The spread of local anesthetics for topical skin analgesia and anesthesia is promoted by influencing the penetrating property physically (eutectic mixture), electrically (iontophoresis), and encapsulating in liposomes. The penetration (spread) of the local anesthetic through the skin is significantly faster with iontophoresis and liposomes in comparison with the eutectic mixture of local anesthetics.     

Changes in treatment of advanced laryngeal cancer 1985-2001

OBJECTIVE: In 1991, a randomized study was published and demonstrated that use of nonsurgical therapy (chemoradiation) provided similar survival to total laryngectomy (the gold standard) for patients with advanced-stage laryngeal cancer. The purpose of this study was to assess how treatment of advanced laryngeal cancer was influenced by such developments in non-surgical therapy. STUDY DESIGN: Patterns of care study using National Cancer Database (1985-2001). RESULTS: The percentage of advanced-stage patients treated with chemoradiation increased from 8.3% to 20.8% while the proportion treated with radiation alone decreased from 38.9% to 23.0%. Use of chemoradiation increased at a significantly faster rate after the 1991 publication at both community cancer centers and teaching research facilities. The use of total laryngectomy decreased slightly during this period. CONCLUSIONS: The use of chemoradiation increased after the 1991 publication. It was impossible to determine from the NCDB whether additional patients who could benefit from chemo-RT were not offered or did not complete this treatment option. We recommend that treatment recommendations discussed at tumor boards be recorded in cancer registries.