A prospective randomized comparison of curved array and radial echoendoscopy in patients with esophageal cancer

BACKGROUND: Both curved array and radial scanning echoendoscopy are used for locoregional staging of cancer arising in the esophagus or cardia. The accuracy of TNM staging of these malignancies by curved array and radial EUS was compared in a prospective, randomized study. METHODS: Patients with cancer of the esophagus or cardia were examined by both curved array and radial echoendoscopy in randomized order by the same endosonographer in an unblinded fashion. The staging results and the examination time for the two echoendoscopies were compared and statistically analyzed, and finally compared with surgical and histopathologic staging. RESULTS: A total of 104 patients underwent EUS; 36 had surgical resection of the tumor, 26 surgical exploration without resection, and 42 did not undergo surgery. Comparison of the TNM staging results for the two echoendoscopies gave high kappa values (T, 0.77; N, 0.75; M, 0.89), indicating excellent agreement. The accuracy of curved array echoendoscopy and radial echoendoscopy by component of the TNM staging system were, respectively, T, 72% and 73%; N, 70% and 77%; and M, 61% and 57%. Mean procedure time for the curved array and radial examinations was, respectively, 15 and 12 minutes (p<0.01). CONCLUSION: There was no clinically relevant difference between curved array and radial echoendoscopy in the staging of cancer of the esophagus or cardia. The choice of echoendoscope for TNM staging in patients with these malignancies is, therefore, a question of personal preference.     

Client-centred practice from the perspective of Danish patients with hand-related disorders

Purpose: The objectives of this study were to investigate perceptions of client-centred practice among Danish patients with hand-related disorders engaged in rehabilitation at outpatient clinics, and to decide on domains to serve as a conceptual foundation for item generation in the development of a new, standardized questionnaire to evaluate the experience of client-centredness among patients with hand-related disorders.

Method: Focus group interviews were held with 25 patients with hand-related disorders from six outpatient hand clinics in Denmark. Deductive content analysis was used to decide on domains for item generation.

Results: Patients found that information was paramount in understanding their situation and to feel empowered and motivated. They attached importance to participation in decision making so that rehabilitation was considered meaningful. Moreover, they thought rehabilitation should be individualized by taking their life situations and personalities into account. Six domains were found to be central to client-centred practice: patient participation in decision making, client-centred education, evaluation of outcomes from patient’s perspective, emotional support, cooperation and coordination, and enabling occupation.

Conclusions: The domains can be used in the further development of a Danish questionnaire to evaluate the experiences of client-centredness among patients engaged in rehabilitation at outpatient clinics for hand-related disorders.

• Implications for rehabilitation

• Patients with hand-related disorders wish for rehabilitation to be tailored to individual needs.

• The patient’s life situation and personality, including coping ability, are important factors to consider in rehabilitation planning, interventions, and evaluations.

• Patients with hand-related disorders attach importance to information and require health professionals’ support to manage their activities of everyday life.

• Patients with hand-related disorders ask for participation and shared decision making in rehabilitation planning.

     

Repeatability of Cervical Joint Flexion and Extension Within and Between Days

Objective

The purpose of this study was to investigate within- and between-day repeatability of free and unrestricted healthy cervical flexion and extension motion when assessing dynamic cervical spine motion.

Greater Risk of Dementia When Spouse Has Dementia? The Cache County Study

OBJECTIVES: To examine the effects of caring for a spouse with dementia on the caregiver's risk for incident dementia. DESIGN: Population‐based study of incident dementia in spouses of persons with dementia. SETTING: Rural county in northern Utah. PARTICIPANTS: Two thousand four hundred forty‐two subjects (1,221 married couples) aged 65 and older. MEASUREMENTS: Incident dementia was diagnosed in 255 subjects, with onset defined as age when subject met Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria for dementia. Cox proportional hazards regression tested the effect of time‐dependent exposure to dementia in one's spouse, adjusted for potential confounders. RESULTS: A subject whose spouse experienced incident dementia onset had a six times greater risk for incident dementia as subjects whose spouses were dementia free (hazard rate ratio (HRR)=6.0, 95% confidence interval (CI)=2.2–16.2, P<.001). In sex‐specific analyses, husbands had higher risks (HRR=11.9, 95% CI=1.7–85.5, P=.01) than wives (HRR=3.7, 95% CI=1.2–11.6, P=.03). CONCLUSION: The chronic and often severe stress associated with dementia caregiving may exert substantial risk for the development of dementia in spouse caregivers. Additional (not mutually exclusive) explanations for findings are discussed.     

Clinical features and predictors of mortality in admitted patients with community- and hospital-acquired legionellosis: A Danish historical cohort study

Background  

Legionella is a common cause of bacterial pneumonia. Community-acquired [CAL] and hospital-acquired legionellosis [HAL] may have different presentations and outcome. We aimed to compare clinical characteristics and examine predictors of mortality for CAL and HAL.     

MRI verified STN stimulation site – gait improvement and clinical outcome

Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in alleviating Parkinson’s disease (PD) symptoms (tremor, rigidity and bradykinesia) and may improve gait and postural impairment associated with the disease. However, improvement of gait is not always as predictable as the clinical outcome. This may relate to the type of gait impairment or localization of the active DBS contact. Methods: The active contact was visualized on peri‐operative magnetic resonance imaging in 22 patients with idiopathic PD, consecutively treated with bilateral STN DBS. Stimulation site was grouped as either in the dorsal/ventral STN or medial/lateral hereof and anterior/posterior STN or medial/lateral hereof. The localization was compared with relative improvement of clinical outcome (UPDRS‐III). In 10 patients, quantitative gait analyses were performed, and the improvement in gait performance was compared with stimulation site in the STN. Results: Of 44 active contacts, 77% were inside the nucleus, 23% were medial hereof. Stimulation of the dorsal half improved UPDRS‐III significantly more than ventral STN DBS (P = 0.02). However, there were no differences between anterior and posterior stimulation in the dorsal STN. Step velocity and length improved significantly more with dorsal stimulation compared with ventral stimulation (P = 0.03 and P = 0.02). Balance during gait was also more improved with dorsal stimulation compared with ventral stimulation. Conclusions: Deep brain stimulation of the dorsal STN is superior to stimulation of the ventral STN. Possible different effects of stimulation inside the nucleus underline the need for exact knowledge of the active stimulation site position to target the most effective area.     

Infusions of albumin increase free fraction of naproxen in healthy volunteers: a randomized crossover study

Background: In vitro and in vivo studies have indicated that stabilizers present in pharmaceutical‐grade albumin influence the albumin‐binding capacity for highly protein‐bound drugs. However, the half‐life of the stabilizers and the quantitative effect have been difficult to determine. Method: A randomized crossover study including six healthy volunteers was performed. The study subjects received 750 mg of oral naproxen 2 h before the study. They were randomized to receive either 100 ml of 20% albumin or 100 ml of Ringer's acetate solution intravenously. Frequent blood samples were obtained. The experiment was repeated 4 weeks later with the alternate solution. The serum samples were analysed to determine the concentrations of albumin, N‐acetyl‐dl ‐tryptophan, caprylate, and naproxen. Results: The free fraction of naproxen increased significantly after the infusion of albumin (P<0.05). The increase was concurrent with the appearance of N‐acetyl‐dl ‐tryptophan and caprylate in serum. The free fraction of naproxen declined rapidly after the albumin infusion was completed. N‐acetyl‐dl ‐tryptophan had a half‐life of approximately 30 min. The half‐life of caprylate was <15 min. Conclusion: A transfusion of albumin results in an increase in the free fraction of naproxen. The transient increase in free‐fraction naproxen decreased together with the detectable levels of the stabilizers N‐acetyl‐dl ‐tryptophan and caprylate. N‐acetyl‐dl ‐tryptophan and caprylate have a short half‐life in serum.