The Impact of Psychiatric Comorbidity on the Return to Work in Patients Undergoing Herniated Disc Surgery

Introduction This study examines (1) return to work (RTW) and ability to work (ATW) rates, and the association with (2) psychiatric comorbidity and (3) socio-demographic, illness-related, vocational and rehabilitation-related characteristics in herniated disc surgery patients. Methods In this longitudinal observational study 305 consecutive patients took part in face-to-face interviews during hospital stay. 277 patients also participated in a 3-month follow-up survey via telephone (drop-out rate 9%). Psychiatric comorbidity was assessed with the Composite International Diagnostic Interview (CIDI-DIA-X). Calculations were conducted via Chi-Square tests, independent T-tests and binary logistic regression analyses. Results 40.1% of the herniated disc patients in this study were able to RTW, 44.4% had regained their ATW 3 months after surgery. Psychiatric comorbidity appeared to be an important risk factor for RTW and ATW. Other risk factors were lower educational qualification, unemployment status, a lower subjective prognosis of gainful employment, a higher number of herniated discs in medical history, cervical disc surgery, and the existence of other chronic diseases, a longer hospital stay and higher pain intensity. Patients who did not RTW, or did not regain their ATW participated more often in inpatient rehabilitation. Conclusions Identifying a high risk group for RTW and ATW at an early age is of utmost importance for the purpose of improving rehabilitation effects and to make a return to the work place easier. Specific interventions, such as social-medical counselling, pain therapy and management, as well as the assistance of mental health professionals during hospital and rehabilitation treatment are recommended for this risk group.     

Full-thickness diaphragmatic resection for stage IV ovarian carcinoma using the EndoGIA stapling device followed by diaphragmatic reconstruction using a Gore-tex graft: a case report and review of the literature

BACKGROUND: Previous studies have reported the results of full-thickness diaphragmatic resection for ovarian cancer metastatic to the diaphragm. CASE.: We present the first case of an extensive full-thickness diaphragmatic resection performed using the EndoGIA [US Surgical Corp., Norwalk, CT] staple device followed by successful reconstruction using a Gore-tex (W.L. Gore and Associates, Inc., Newark, DE) graft. CONCLUSION: Full-thickness diaphragmatic resection using the EndoGIA stapling device is a safe and effective method to completely remove extensive tumor during cytoreductive surgery. Use of the stapler expeditiously assists in removal of the specimen with minimal blood loss. In cases where large defects cannot be repaired primarily, a Gore-tex patch should be used.     

Influence of bleaching agents and desensitizing varnishes on the water content of dentin

This in vitro study investigated the possible dehydration of dentin caused by bleaching agents. Furthermore, it tested whether protective dentin varnishes can maintain the physiological moisture of dentin during bleaching treatment. Fifty-five standardized dentin cylinders were prepared from freshly extracted bovine incisors under constant water irrigation. Prior to bleaching, the treatment specimens were conditioned at room temperature in a hygrophor for 14 days. The samples were divided into 11 groups. The Group A specimens, which were completely dehydrated, and Group B, which was stored for 2 weeks in a hygrophor, served as controls (A, B n=5). The other samples (n=10 each group) were coated with Vivasens [VS] (C), Bilfuorid [BF] (D) and Seal&Protect [SP] (E). Five specimens from each group (C-E) were subsequently treated with an experimental bleaching gel (Exp BG) (20% carbamide peroxide [CP], glycerine-based gel): Cb, Db, Eb. The remaining specimens were bleached with Exp BG (F) only, Vivastyle (G: 16% CP, glycerine-based gel) or Vivastyle Paint On (H: 6% CP-varnish) for 7 days (n=5 each group) with bleaching time for gels: 2 hours/day, paint on: 20 minutes/day. After the respective treatments, the overall water content of each specimen was determined using the analytical method of Karl-Fischer-titration. The water content of bovine dentin (Group B, mean%+/-SD) obtained in this study amounted to 15.24+/-0.4. All bleaching products significantly reduced the water content compared to the controls (exp BG: 13.32+/-0.47, Vivastyle 13.2+/-0.27, paint on 13.72+/-0.54; p<0.05). Also, application of SP before bleaching resulted in reduced water content (14.06+/-0.12; p=0.0005). However, bleaching with exp BG following use of VS (14.99+/-0.42) or SP (13.85+/-0.26) did not result in a reduction of water content in dentin. Pretreatment with BF did not protect dentin from water loss during bleaching (12.44+/-0.38; bi p=0.0009). All glycerine-based bleaching products used in this study had a significant dehydrating effect on dentin. The application of protective varnishes prior to bleaching treatment may reduce or even prevent dentin dehydration.     

The meaning of caring from the viewpoint of patients with wounds due to peripheral vascular disease

This qualitative study describes the meaning of Caring from the viewpoint of the patient with chronic wounds due to peripheral vascular disease (PVD). Because the meaning of Caring can not be understood independent from the life context of the persons involved, the following questions have been formulated: 1) What influence does living with chronic wounds have on the everyday life of the patient? 2) What is the meaning of Caring for patients with chronic wounds? To answer these questions, qualitative research methods according to Mayring were chosen. A convenience sample of twelve patients, seven women and five men, with ages ranging from 69 to 86 years (median 77 years), were interviewed from April to November 2002. Data were analyzed according to Mayring (2000) through content analysis. The results show that the everyday life of the patient is strongly influenced by the effects of having chronic wounds. Patients view their lives with chronic wounds, the effects on their day to day life and the support from health professionals and family caregivers as a whole. Patients differentiate between Caring from Health professionals and Caring from family caregivers. Caring from health professionals is described primarily in the context of treatments and support situations. Caring from family caregivers is experienced as a part of the everyday life. Patients assume that healthcare professionals have the needed expertise, knowledge and skills. They hope, however, to be valued and respected and describe these characteristics as "kind and nice". When patients experience these attitudes from the nurses they feel they are taken seriously and are cared for. This is a requirement to enable or empower patients to understand and implement their treatment regimen. Caring must always be an element of nursing care and determines the standard of the quality of the patient-nurse relationship.     

Localization of glial aquaporin-4 and Kir4.1 in the light-injured murine retina

Excessive light causes damage to photoreceptor and pigment epithelial cells, and a local edema in the outer retina. Since Müller glial cells normally mediate the osmohomeostasis in the inner retina (mainly via channel-mediated transport of potassium and water), we determined whether retinal light injury causes an alteration in the retinal localization of glial water (aquaporin-4) and potassium (Kir4.1) channels, and in the potassium conductance of Müller cells. Mice were treated with bright white light (intensity, 15,000lx) for 2h. Light treatment results in Müller cell gliosis as indicated by the enhanced staining of the glial fibrillary acidic protein and an increase in the cell membrane area reflecting cellular hypertrophy. In light-injured retinas, the immunostaining of the photoreceptor water channel aquaporin-1 disappeared along with the degeneration of the outer retina, and the outer nuclear layer contained large spherical bodies representing photoreceptor nuclei which were fused together. The immunostainings of the aquaporin-4 and Kir4.1 proteins were increased in the outer retina after light treatment. Since the amplitude of the potassium currents of Müller cells remained largely unaltered, the increase in the Kir4.1 immunostaining is supposed to be caused by a redistribution of the channel protein. The data indicate that Müller glial cells respond to excessive light with an alteration in the localization of Kir4.1 and aquaporin-4 proteins; this alteration is thought to be a response to the edema in the outer retina and may support the resolution of edema.