Variations in screening and management practices for subsequent asymptomatic meningiomas in childhood,adolescent and young adult cancer survivors

Journal of Neuro-Oncology - Childhood, adolescent and young adult (CAYA) cancer survivors treated with cranial radiotherapy are at risk for developing subsequent meningiomas. There is insufficient...     

Working Alliance in Patients with Severe Mental Illness Who Need a Crisis Intervention Plan

Working alliance has been characterized as an important predictor of positive treatment outcomes. We examined whether illness insight, psychosocial functioning, social support and locus of control were associated with working alliance as perceived by both patient and clinician. We assessed 195 outpatients with psychotic or bipolar disorders. Our findings indicated that patients rated the alliance more positively when they experienced a greater need for treatment, fewer behavioral and social problems, and more psychiatric symptoms. Clinicians rated the alliance more positively in patients who reported fewer social problems and better illness insight. Patients’ demographic characteristics, including being female and married, were also positively related to the clinician-rated alliance. Our results suggest that patients and clinicians have divergent perceptions of the alliance. Clinicians may need help developing awareness of the goals and tasks of patients with certain characteristics, i.e., singles, men, those with poor illness insight and those who report poor social functioning.     

Communication Between HIV Patients and Their Providers: A Qualitative Preference Match Analysis

Since the introduction of cART (combination antiretroviral therapy), HIV has evolved into a chronic disease such that it requires lifelong medical treatment to which patients must adhere. Communication with health care providers is pivotal in supporting patients to adapt to having HIV and adhering to treatment, in order to maintain health and quality of life. Previous research indicates that communication is optimal when it matches patient preferences for information exchange, relationship establishment, and involvement in treatment decisions. The aim of the present study is to explore HIV patient communication preferences as well as patient experiences with their providers (not) matching their preferences. A second aim is to explore provider beliefs about patient preferences and provider views on optimal communication. Data were collected through interviews with 28 patients and 11 providers from two academic hospitals. Results indicate that patient preferences reflect their cognitive, emotional, and practical needs such that patients look to increase their sense of control over their HIV. Patients aim to further increase their sense of control (by proxy) through their relationship with their providers and through their decisional involvement preferences. Providers are well aware of patient communication preferences but do not explicate underlying control needs. Implications for clinical practice are discussed.     

Antibacterial effect of chlorhexidine- containing glass ionomer cement in vivo: a pilot study

This in vivo pilot study was carried out to test the antibacterial effect of glass ionomer containing chlorhexidine (test group) in comparison to conventional glass ionomer (control group). Fifty 6- to 11-year-old children with one occlusal lesion in a molar were randomly allocated to test and control groups in a parallel-group design. The cavity walls and one half of the floor were cleaned and restored with one of the materials without dentine conditioning. The restorations were removed after 7 days. Dentine samples were taken from the cleaned (affected dentine) and noncleaned area (infected dentine) at baseline and at day 7. Samples were anaerobically and aerobically cultivated for mutans streptococci, lactobacilli and total viable bacterial count (TVC) following common laboratory procedures. ANCOVA was used to test for treatment effects. Seven days after treatment, a significant decrease in anaerobic and aerobic bacterial counts (p = 0.0001) was shown. Lower numbers of anaerobic lactobacilli (p = 0.02), TVC (p = 0.008) and aerobic lactobacilli and TVC (p = 0.03), but not of mutans streptococci, were indicated in the test group compared to the control group. A significant reduction in aerobic lactobacilli from infected dentine treated with the glass ionomer containing chlorhexidine (p = 0.05) was observed whereas in affected dentine, anaerobic mutans streptococci, lactobacilli and TVC and aerobic TVC and mutans streptococci were significantly lower in the test group 7 days after treatment (p = 0.01). We conclude that the present pilot study revealed lower microorganism counts in chlorhexidine-containing glass ionomers than in conventional glass ionomers for both affected and infected dentine over a 7-day period.     

Trends in caries prevalence in 5-, 7- and 11-year-old schoolchildren in The Hague between 1969 and 1989.

Starting in 1969, periodic cross-sectional examinations of schoolchildren have been carried out in the city of The Hague. In 1989 the periodic examinations were continued and, in general, caries prevalence was found to be very low; D3MFS values ranged between 1.5 and 2.2 at age 11.8 years. Compared to 1984, 5-year-old-children of low and medium socio-economic levels (SES) in 1989 had significantly higher d3mfs values (p less than 0.01), mainly due to a marked increase in decayed surfaces per child; a significant increase in caries experience of the deciduous dentition amongst 7-year-olds of low social level was found (p less than 0.01). A further reduction of D3MFS values for 7-year-old children of low and medium SES could be observed in 1989 compared to 1984. Between 1978 and 1989 a marked D3MFS reductions amongst 11-year-olds in the three social levels was found. Possible explanations for the observed differences in caries experience between 1984 and 1989 are discussed.     

"Prosthetic condition" and satisfaction with dentures

This study introduces the concept of 'prosthetic condition', combining the professionally assessed complete denture quality and quality of the residual alveolar ridge. In a group of 397 complete maxillary and mandibular denture wearers the prosthetic condition was assessed and the denture satisfaction recorded. The total prosthetic condition (maxillary and mandibular combined) was good in 225 (57%), moderate in 81 (20%), and poor in 91 (23%) subjects; the mandibular prosthetic condition was good in 155 (39%), moderate in 148 (38%), and poor in 94 (23%) subjects; 297 (75%) subjects were satisfied with their dentures. None of the criteria used for the prosthetic condition could explain the denture satisfaction. Furthermore, there was no significant correlation between prosthetic condition and denture satisfaction.     

Split rib cranioplasty for aplasia cutis congenita and traumatic skull defects: more than 30 years of follow-up

Aplasia cutis is a rare skin defect usually presenting over the vertex of the skull. An underlying bone defect is found in approximately 20% of patients. Most skull defects close spontaneously. However, when there are no signs of ossification, closure is mandatory. We present our experience in three patients. Our first patient had an aplasia cutis with a skull defect. The split rib graft procedure was used without complications, and a good cosmetic and functional result was achieved. The second patient was operated on for cerebral bleeding after an arteriovenous aneurysm, and a bony defect could not be closed after that procedure. At a later stage, the defect was filled with split rib grafts, and sufficient protection was achieved and documented after more than 30 years. The third patient was born with an aplasia cutis congenita with a skull defect. The bony defect was filled with split rib grafts without complications at an age of 5 years. Follow-up shows a functional result with a firm skull. Patients with aplasia cutis may have skull defects that will not close by themselves. We present three patients with a bony defect who were reconstructed with split rib grafts. After a long period of follow-up, there remains good cosmetic and functional results. Defects of the skull in children can be reconstructed with split rib grafts that will accommodate the growing skeleton and give good protection of the brain from an early age on.