CT detection of sacral osteomyelitis associated with pelvic abscesses

In three patients the diagnosis of sacral osteomyelitis was made when CT demonstrated intraosseous (two) and intraforaminal (one) gas. Two of the three patients also had radionuclide bone scans, one of which was unremarkable. In the other case, radionuclide scintigraphy greatly underestimated the extent of the disease process when compared with CT. All three patients had contiguous pelvic abscesses as a cause of the osteomyelitis. Although there was a high clinical suspicion for an intraabdominal process, the diagnosis of superimposed osteomyelitis of the sacrum was unsuspected. The detection of intraosseous gas is a pathognomonic, albeit uncommon, manifestation of osteomyelitis. Although the radionuclide bone scan is the method of choice for detecting osteomyelitis, CT should be used as a complementary study in certain patients.     

INFANTILE MYOFIBROMATOSIS WITH HEMANGIOPERICYTOMA-LIKE FEATURES OF THE TONGUE: A Case Study Including Ultrastructure

We report a case of an infantile myofibromatosis with hemangiopericytoma-like features arising in the tongue of a 5-month-old female infant. Many authors now classify neoplasms as infantile myofibromatosis that were previously called infantile hemangiopericytoma. The ultrastructural features of our tumor illustrate its biphasic nature and provide a possible explanation for its histogenesis. Infantile myofibromatosis, including those diagnosed as infantile hemangiopericytomas, rarely arise in any intraoral location. Despite the generally good prognosis associated with these neoplasms, complete surgical excision is recommended to avoid recurrences.     

Predictive model of coronary heart disease in Egypt (a disease with multiple risk factors)

As a multifactorial disease and with the need of primordial prevention coronary heart disease (CHT), a risk scoring system for the prediction of CHD was devised at Community Medicine Department Ain Shams University, Cairo, EGYPT. In this matched case-control study of 119 cases and 121 age and sex matched controls, current cigarette smoking, lack of siesta, hypertension, diabetes mellitus, low occupational physical activity, hypercholesterolemia, marital status, urban residence, level of education, work index, coffee consumption, positive family history, BMI, elevated W/H ratio, low HDL and elevated TC/HDL were studied for association with CHD. The additive risk scoring system based on the results of conditional multiple logistic regression identified the first six factors with statistical weights of 1, 5, 10, 6, 6, 11, respectively. On back validation receiver operating characteristic (ROC) curve, a total score of 17 was found to be the cut off point above which there was increased risk of CHD. The overall predictive accuracy of this system--equivalent to the area under the ROC curve--was 0.873. Future studies need to assess the risk scoring system in population based studies.     

Incidence of non-AIDS-defining cancers before and during the highly active antiretroviral therapy era in a cohort of human immunodeficiency virus-infected patients.

PURPOSE: To determine incidence of non-AIDS-defining cancers (NADC) in HIV-infected patients before (P1) and during (P2) the use of highly active antiretroviral therapy (HAART) relative to that observed in the French general population (FGP) of the same age and sex. PATIENTS AND METHODS: Sex- and age-adjusted NADC standardized incidence ratios (SIR), with FGP as reference, were estimated in 1992 to 1995 (P1) and in 1996 to 1999 (P2) in a French Hospital Database on HIV prospective hospital cohort study. RESULTS: NADCs were diagnosed in 260 patients during P1 and 391 patients during P2 among the 77,025 patients included in the database between January 1, 1992, and December 31, 1999. Estimated incidence of all cancers was higher in HIV-infected men than in FGP during both periods (P1 SIR = 2.36 and P2 SIR = 1.91). No excess of cancers was observed among HIV-infected women in either period. Incidence of all cancers did not change from P1 to P2 in either sex (SIR = 0.96 for men and 1.00 for women). In contrast, incidence of Hodgkin's disease (HD) was higher than in FGP in both sexes and both periods and increased in P2 as compared with P1; incidence of lung cancer was higher in both sexes during P2. CONCLUSION: Relative to FGP, the overall incidence of NADCs was increased in HIV-infected men but not in women and did not differ between P1 and P2. Only HD was much more common in HIV infection, and the potential role of HAART on HD cannot be excluded.     

Adrenergic effects on secretion of amylase from the rat salivary glands

The present study was undertaken to investigate the effect of adrenergic agents on secretion of amylase from the salivary glands in vivo. Saliva was collected from the distal oesophagus in conscious rats. Adrenaline increased the concentration of amylase in saliva and serum significantly. The result of infusion of alpha- and beta-adrenergic antagonists as well as noradrenaline and isoproterenol showed that secretion of salivary amylase is predominantly mediated by stimulation of beta-adrenergic receptors, especially of the beta 1-subtype. Investigation of the isoenzyme pattern in saliva, pancreatic juice and serum demonstrated that the major component in serum is salivary amylase. This study has shown that beta-adrenergic agents stimulate secretion of amylase from the salivary glands in rats. Though the secretion is mainly exocrine small amounts of amylase is found in serum, which seems to originate from the salivary glands.     

A Computerized Order Entry System Was Adopted with High User Satisfaction at an Orthopedic Teaching Hospital

Background

Computerized provider order entry (CPOE) has been considered essential for the reduction of medical errors and increased patient safety. Assessment of staff perception regarding a CPOE system is important for satisfaction and adoption. Incorporation of user feedback can greatly improve the functionality of a system and promote user satisfaction.

Questions/Purposes

This study aims to develop an informatics staff satisfaction survey instrument and to understand what components of computerized prescriber order entry (CPOE) contribute to staff satisfaction and its variability over time.

Methods

The 22-question survey was developed by a multidisciplinary group and focused on patient data including demographics, orders, medications, laboratory, and radiology data. The questions were designed to understand if clinicians (1) could easily access the information needed to properly take care of patients, (2) could act upon the information once acquired, (3) could obtain the information clearly, and (4) were alerted to potential errors. The survey was distributed just prior to “go-live,” 6 and 12 months after go-live. Responses were given on a five-point Likert scale.

Results

The survey results post-implementation showed user satisfaction with CPOE. Satisfaction regarding the ease of obtaining orders, medication, and lab data had a significant improvement at 6 and 12 months post-implementation, p < 0.001. Satisfaction that the computerized order entry system provided information needed to take care of their patients improved, p < 0.01. At 1 year post-implementation, user satisfaction declined from 6 months earlier but still demonstrated an overall increase in satisfaction from pre-implementation.

Conclusion

Compared prior to go-live, clinicians are satisfied or very satisfied across multiple spheres and multiple disciplines. At all time points, clinicians were able to obtain information required to take care of their patients. However, post-go-live, it was easier to obtain and act upon as well as more clear and understandable.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-013-9377-1) contains supplementary material, which is available to authorized users.     

Work-related exacerbation of asthma

Adults with asthma who had been enrolled in an HMO for at least a year were requested to complete a questionnaire about their health status. Approximately 25% of the 1,461 participants responded positively to "Does your current work environment make your asthma worse?" and were classified as having workplace exacerbation of asthma. Those with workplace exacerbation were more likely to have never attended college, be current or former smokers, have a history of other respiratory diseases, have missed work or usual activities at least one day in the past for weeks, and report their asthma was moderate, severe, or very severe. Percentages with workplace exacerbation of asthma were highest for mining and construction (36%), wholesale and retail trade (33%), and public administration (33%), and lowest for educational services (22%), finance, insurance, and real estate (22%), and non-medical and non-educational services (18%). Future studies are needed for objective validation of self-reported workplace exacerbation, and to follow subjects prospectively to clarify the temporal sequence of workplace exacerbation and asthma severity, and how other respiratory conditions and smoking might contribute to work-related worsening of asthma.