Soluble cell adhesion molecules in gingival crevicular fluid in periodontal health and disease

BACKGROUND: Cell adhesion molecules (CAMs) are cell surface proteins involved in the binding of cells to each other, to endothelial cells, or to the extracellular matrix. The soluble forms of CAMs (sCAMs) are thought to be produced by proteolytic cleavage from the cell surface and are shed into the gingival crevicular fluid (GCF). The aim of this study was to investigate whether sCAMs, sICAM-1, sVCAM-1, and sE-Selectin were present in GCF in both periodontal health and disease and to examine their relationship with periodontal inflammation. METHODS: GCF was collected from a clinically healthy, a gingivitis, and a periodontitis site in 29 subjects with chronic periodontitis and from a single clinically healthy site in 22 subjects without chronic periodontitis. The volume of GCF was measured and each sample was analyzed for sCAMs by enzyme-linked immunosorbent assay (ELISA). The effect of treatment (oral hygiene instruction, scaling and root planing) on the levels of sCAMs in each site of the diseased group was also investigated. RESULTS: Statistically significant differences (P < 0.05) were found between the levels of sVCAM-1 in periodontal health and disease. These results indicate that changes in the levels of sCAMs may be a sensitive indicator to differentiate healthy sites from those with periodontitis. Statistically significant changes in the levels of sICAM-1 were recorded after treatment (P < 0.05). CONCLUSIONS: Further studies are required to establish if these potential biomarkers will enable the identification of those sites most at risk for disease progression and also evaluate the response to treatment, thereby playing a preventive role in the pathogenesis of periodontal disease.     

Reversal theory states and cigarette availability predict lapses during smoking cessation among adolescents

Although 67% of adolescent smokers say they want to quit, only 7% are able to do so. The purpose of this study was to use metamotivational states as described in reversal theory to predict whether adolescents who are trying to quit smoking will lapse (smoke a cigarette) or will resist smoking in highly tempting situations. Reversal theory holds that individuals switch between telic (serious-minded) and paratelic (playful) metamotivational states. Questionnaires and semistructured interviews were administered to 62 adolescents ages 14-19 who had participated in a smoking cessation program. Interviews were coded according to the Metamotivational State Interview and Coding Schedule, and the resulting data were analyzed using logistic regression analysis. Adolescents in the paratelic metamotivational state (OR = 15.34; 95% CI: 5.3, 43.6) or with cigarettes readily available (OR = 4.6; 95% CI: 1.6, 13.2) were more likely to lapse than were adolescents in the telic state or who required effort to obtain cigarettes. The variables telic/paratelic state and cigarette availability accurately predicted the outcome of highly tempting situations 80% of the time. Using reversal theory constructs to develop state-specific strategies shows promise as an additional tool for those in this age group coping with the temptation to smoke.     

Thrombosis in inflammatory bowel disease: clinical setting, procoagulant profile and factor V Leiden

Patients with inflammatory bowel disease have an increased frequency of thromboembolism, and microvascular thrombosis has been proposed as a contributory pathogenic factor. The mechanism of enhanced procoagulant activity is not understood. We examined the clinical setting of thromboembolic events in 52 patients with Crohn's disease or ulcerative colitis, and assessed the procoagulant laboratory profile, including Factor V Leiden, in a subset of 20 patients to identify procoagulant risk factors. Patients who developed thrombosis tended to be young; 60% of thrombotic events occurred in patients under 50 years. Multiple thromboembolic episodes occurred in 13% and unusual sites of thrombosis (e.g. intracardiac, cerebral, inominate veins) in 11%. No risk factor was identifiable in 52% of cases and two-thirds of thromboses occurred in an out-patient setting. The mortality rate was 8%. Evidence for inflammatory disease activity was found in only 45% of patients with ulcerative colitis at the time of the thromboembolic event, in contrast to 89% of those with Crohn's disease. Assays for specific coagulation defects were negative in all cases tested (protein S, C were normal in 17/17; anti-thrombin III, anti-phospholipid antibodies and activated protein C resistance were negative in 20/20, and only 1/20 patients was found to be heterozygous for Factor V leiden. Thrombosis in inflammatory bowel disease is important because it occurs in a young population, often in unusual sites, and has a high mortality. The development of thrombosis is related to active inflammatory disease in most patients with Crohn's disease but apparently not in those with ulcerative colitis. Since approximately half of the patients had no other identifiable risk factor, there remains a substantial group of patients with IBD who develop thrombosis for unknown reasons.      

Development of an integrated care pathway for the management of hemiplegic shoulder pain

Purpose: To improve clinical management of patients with hemiplegic shoulder pain through development of an evidence-based multidisciplinary integrated care pathway (ICP), and to use this to audit quality of care against predefined standards. Methods: The ICP was developed by a team of medical, paramedical and nursing staff. The evidence base was established through a systematic literature review supplemented by clinical consensus to ensure best practice where scientific evidence was lacking. Following development, performance was assessed against standards in a cohort of stroke patients with hemiplegia (n=32) consecutively admitted to a regional unit providing in-patient rehabilitation for young patients with complex disabilities. Results: Performance showed improvements in assessment and documentation of pain and in initial care, including analgesia and application of positioning/handling protocols. However, review and response to continuing or changing symptoms were poorly documented. Changes to the ICP were introduced to improve this. Conclusions: Principal benefits have been to raise awareness of shoulder pain, to educate staff and prompt management in line with recommended best practice, but strong leadership is essential to ensure continuity in clinical practice. Future research is needed to establish whether improved quality of care offsets the substantial investment of staff time in ICP development.     

Care needs and functional status of older acute care patients

A growing number of older adults are admitted to hospitals, and information is needed on how age-related functional decline affects nursing care needs of this population. This study compared the functional status at admission and total nursing care needs of three age groups of older inpatients. A 12-month retrospective audit was performed on the records of 225 patients in a private metropolitan hospital. The three groups of patients were matched on diagnosis. Findings revealed that older patients were significantly more dependent, had greater total nursing care needs, and were less likely to be discharged to home, indicating that in addition to medical diagnoses, age-related differences of older patients' functional status at admission and inpatient nursing care needs should be factored into staff workloads and funding of nursing care. The finding that significantly fewer of the older patients returned home must be considered when reviewing health care policy and services.