Right on target?

Targets have become an integral part of health care, whether we agree with them or not. Many accept the progress made with the use of targets, but our duty as health professionals is to ensure that their use and interpretation is undertaken with the same care and understanding of their limitations that we apply to our clinical practice, and that they are not mis-interpreted or used to justify the latest political idioms. Currently the healthcare profession is failing to understand the consequences of setting targets, or the wider implications of hitting them. This article aims to summarise how we can learn from past experiences to become more aware of the benefits and draw-backs of targets in healthcare, and how we can utilise them more efficiently in health care.     

Thinking on trauma research

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Study on the effect of glucocorticoid on apoptosis of rat spermatogenic cells

The effect of glucocoiticoid on the apoptosis of rat spermato-genic cells labeled with TUNEL was observed in vivo by laser con-focal microscopy and electron microscopy. The results showed thatlarge doses of glucocorticoid increased the apoptosis of rat spermto-genic cell. (Chin J Androl 2001; 2: 98-101)     

Hallux Valgus Evaluation on MRI: Can Measurements Validated on Radiographs Be Used?

Hallux valgus (HV) is a common deformity of the great toe affecting >23% of adults in the United States. The severity of the deformity is traditionally analyzed using radiographs to determine measurements such as the HV and intermetatarsal angles. We sought to determine the relationship between the radiographic and magnetic resonance imaging (MRI) measurements because this is not yet known. Two of us analyzed a series of 56 consecutive patients who had had radiographs and MRI performed on the same foot between April 27, 2015 and March 9, 2016 and who satisfied all other inclusion and exclusion criteria (age 18 to 100 years, no history of recent foot trauma, and no metal hardware in the foot). We found excellent interreader reliability (intraclass correlation 0.89 to 0.96) and intermodality agreement (intraclass correlation 0.83 to 0.91). The HV angle measured 15.0°?±?8.8° on the MRI scans and 13.8°?±?8.7° on the radiographs (mean difference ?1.15°?±?3.89°), and the intermetatarsal angle was 9.0°?±?3.1° on the MRI scans and 8.8°?±?2.9° on the radiographs (mean difference ?0.22°?±?2.10°). The HV measurements were reliable on both radiographs and MRI for the range of values tested. Small intermodality statistically significant differences in HV angle measurements were found; however, these might not be enough to be clinically significant.     

Does the impact of urinary incontinence on quality of life differ based on age?

Introduction and hypothesis

The purpose of this study was to evaluate if the impact of urinary incontinence (UI) on quality of life (QOL) differs between women based on age.

Methods

A retrospective review of patients presenting for the management of UI was performed. Patients with UI and their corresponding degree of bother were identified by their responses to validated questionnaires. Distributions of comorbidities and types of UI were presented as frequencies and compared between age cohorts with a chi-square test. Mean scale scores were assessed for normality and a one-way analysis of variance with a post hoc Scheffé’s test was used to compare the scores.

Results

Of 765 patients meeting inclusion criteria, 22.4 % were <45, 28.9 % were 45–55, and 48.8 % were >55 years of age. Women older than 55 were significantly more likely to have urge UI and mixed UI than their counterparts (p?<?0.001). Women <45 and 45–55 were more negatively impacted in their ability to perform physical activities compared to women >55 (p?=?0.004), whereas women >55 were significantly less likely to feel frustrated by their incontinence than women <45 (p?=?0.022). However, there was no significant difference in overall impact of incontinence among groups (p?=?0.585).

Conclusions

UI equally impacts the functional and psychological QOL in women regardless of age. UI in women <55 results in a greater negative impact on level of physical activity, whereas women <45 are significantly more frustrated.     

Culture of osteoblasts on bio-derived bones

Thegoalofrepairingbonedefectsistofacilitatenewbonesgrowingintotheosseousdefects.Therefore, thematerialsusedforboneregenerationshouldsupporttheattachmentandproliferationofosteoblasts. Avarietyofbio derivedandchemosyntheticmaterialsareavailableforthesurgicaltreatmentofalveolarboneloss.1 Autogenousbonegraftsanddemineralizedfreeze driedboneallografts(DFDBA) fromhumancadavershavebeenusedwithadegreeofsuccess. However, neitherisideal. Autogenousbonegraftsinvolveanadditionalproceduretoharvestthebon…     

Effect of adrenalectomy on rat epididymidis

Aim: To investigate the effect of adrenalectomy (ADX) on the epididymidis of Sprague-Dawley rats. Methods: The histological, biochemical (cholesterol protein, zinc, copper, alkaline and acid phosphatase aryl sulphatase, lactic dehydrogenase and leucine amino peptidase) and hormonal (FSH, LH and testosterone) changes of caput and cauda epididymis in ADX rats were observed. Results: Organ wet weight, histological studies and morphometric measurements indicated a cellular degeneration in caput and cauda epididymis of ADX rats. Serum testosterone level was significantly lower in ADX than in sham-operated rats, while the serum FSH and LH were below the detection limit of 1 mIU/mL. The enzymatic activity was higher in ADX than in sham-operated rats. Epididymal zinc level increased whereas copper level decreased in ADX rats compared to the sham-operated. Conclusion: Adrenalectomy leads to degeneration of caput and cauda epididymidis epithelial cells as a result of decreased supply of testosterone. (Asian J And     

Gleason score on biopsy: is it reliable for predicting the final grade on pathology?

OBJECTIVE: To assess the correlation of the Gleason score on biopsy and the final pathology after radical prostatectomy (RP) for prostate adenocarcinoma. PATIENTS AND METHODS: In a retrospective analysis within a tertiary-care centre, the charts of 537 patients who had undergone radical prostatectomy from April 1989 to November 2000 were reviewed. The RPs were undertaken in one institution; 167 biopsies were taken and interpreted in the referring centres, and 355 were taken and interpreted in the authors' institution by up to 15 pathologists. All the final pathology specimens were interpreted by the same group of pathologists. The main outcome measures were: the pathological report of the biopsy including the primary and secondary Gleason grade; the final pathological grade (primary and secondary); the margin status; and the identification of the pathologist for the biopsy and final pathology. RESULTS: In all, 390 patients had inclusion criteria (the Gleason grade before and after RP) available. For the individual scores 38.2% of tumours were undergraded, 32.6% overgraded and only 29.2% had identical grading in preoperative biopsies and final specimens. When grouped into more meaningful categories (Gleason 2-4, 5-6, 7 and 8-10) the correlation improved, with 48.5% of patients remaining in the same group after RP. For 39 patients the same pathologist assessed the biopsy and final specimen; in these cases individual scores were identical in 49% and group scores were identical in 64%. CONCLUSION: Gleason grading of the prostate biopsy remains a poor predictor of pathological outcome. Assessment by the same pathologist reduces the discrepancy but over half the patients are under- or overgraded on final pathology. Clinicians should be aware of these limitations when using the biopsy Gleason grade in decision making.