Use of the Research Diagnostic Criteria for Temporomandibular Disorders for multinational research: translation efforts and reliability assessments in The Netherlands

AIMS: To outline the steps taken to conduct and to culturally adapt Dutch translations of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) history questionnaire, clinical examination form, and verbal instructions to the patients, and to assess the reliability of the clinical examination. METHODS: For the linguistic translation from English into Dutch, the forward and back-translation approach was followed. For cultural adaptation, an expert panel reviewed the translation, and a pretest was performed on a small clinical sample. Examiner training and calibration were carried out, and the clinical reliability of a "gold standard examiner" and 3 clinicians was assessed on 18 symptomatic TMD patients and 6 asymptomatic controls. The order of the examinations was based on a quasi-random Latin square design. Intraclass correlation coefficients (ICCs) were calculated to assess the overall interexaminer reliability of the clinical examination. RESULTS: A linguistically valid and culturally equivalent translation of the RDC/TMD into Dutch resulted from the above-outlined procedure. As for the clinical reliability, the ICC values obtained could mostly be considered "excellent" or, less frequently, as "fair to good." Poor reliability was found only for some of the palpation tests. For uncommon diagnoses (disc displacement without reduction and without limited mouth opening; osteoarthritis), no reliable ICC value could be calculated. CONCLUSION: The mode described by the authors for preparing clinical sites for RDC/TMD-based research is a feasible one.     

Tarsal navicular stress fractures: radiographic evaluation

Tarsal navicular stress fractures are a potential source of disabling foot pain in physically active individuals. The diagnosis of tarsal navicular stress fracture requires a high index of clinical and radiographic suspicion because the fracture is only rarely evident on routine radiographs or standard tomograms. The radiographic diagnosis of a tarsal navicular stress fracture may require anatomic anteroposterior tomograms or a radionuclide bone scan with plantar views. Radiographic examinations of 23 fractures in 21 patients are evaluated.     

Managerial socialization in short-term hospitals: some early evidence

In contrast to business corporations, little has been written about early managerial behavior in short-term, general hospitals. An executive transition into a new organization presents both risk and opportunity. This exploratory study into managerial socialization is aimed at identifying what healthcare executives actually do during the transition period from onset of recruitment to the end of their first 6 months in a new hospital position. The findings of this research should be useful in helping CEOs to plan for their transition into short-term, general hospitals. For these top management executives, the stakes are very high. In many instances, CEOs are expected to change the way their hospitals work. An understanding of the strategic, tactical, political, and cultural approaches they have used should help lead to more successful transition outcomes and effective organizational change.     

The epidemiology of tick-borne relapsing fever in the United States

Each year, many residents of and visitors to endemic regions of the western United States are exposed to the vector of tick-borne relapsing fever (TBRF), an underrecognized and underreported disease. Through review of report forms and literature review, we identified 450 cases of TBRF acquired in the United States in 11 western states (and in British Columbia by a U.S. resident) from January 1977 to January 2000. Exposure sites were in forested areas, at varying elevations, in mountainous regions (Cascade, Rocky Mountain, San Bernardino, and Sierra Nevada ranges) of the United States and Canada and in limestone caves in central Texas. Only 13 counties accounted for approximately 50% of all cases. Forty percent of the cases were not residents of the state where TBRF exposure occurred, including 7% from 11 states where TBRF is not endemic. TBRF is endemic in the United States and is a disease affecting travelers, who may return home with the disease to areas where physicians are not familiar with it.     

The effects of acutely administered cocaine on responding maintained by a progressive-ratio schedule of food presentation

Lever pressing in rats (N=5) was reinforced under a progressive-ratio (PR) schedule of food presentation, in which the number of responses required increased exponentially. The session was terminated when 1 h passed without completion of the scheduled ratio. Doses of cocaine (5.6-42.0 mg/kg; one subject received a dose of 56.0 mg/kg) as well as saline were administered i.p. prior to the session. Under non-drug conditions, breakpoints were typically less than 100, and substantial responding usually occurred only during about the first 10 min of the session. The rate of responding usually increased over the first 2-8 reinforcers and then decreased for the last few reinforcers obtained. For four of five rats, breakpoint, overall rate of response, and session duration were first increased above control and vehicle levels by increasing doses of cocaine. Larger doses produced smaller increases, no effect, or decreases. Cocaine, in the range of doses near the apex of the breakpoint dose-effect functions, suppressed rates of responding at the small ratios present at the beginning of the session. It is suggested that cocaine increases low rates of response if: (1). rates are low due to extinction; and (2). the stimuli present are those present when the response is reinforced.     

Treating the bisexual client

Therapists, having recently come to terms with treating gay and lesbian clients, now must consider the issues that bisexual clients face. This article reviews the literature on what it means to identify as bisexual in a world where sexual identity is viewed as dichotomous, heterosexual at one end and gay or lesbian at the other end. The article explores sexual identity and its biological versus social origins, internalized biphobia, coming out, relationship patterns, and therapist issues. Two cases illustrate issues that might arise when a therapist is treating a bisexual client. The first case is a 17-year-old young woman who is accepting of her bisexual identity, and the second case is a 56-year-old woman, heterosexually identified and married, who suddenly fell in love with a woman. Concluding remarks focus on some future directions for research and work with bisexual clients.     

Pulmonary cystic hydatid disease in Ireland

Background Hydatid disease is rare in Ireland and its incidence and prevalence are unknown. Most cases are diagnosed by a combination of clinical findings, morphological features on imaging and by serological testing. Aims We describe an Irish case of pulmonary hydatid disease detected at bronchoscopy by bronchoalveolar lavage, and discuss the diagnosis and treatment of the disorder.     

Treatment of postherpetic neuralgia: an update

Postherpetic neuralgia (PHN) is a chronic pain syndrome that is often refractory to treatment and can last for years, causing physical and social disability, psychological distress, and increased use of the healthcare system. In this paper we provide an update on recent developments in the treatment of PHN. We emphasise the results of recent studies that provide an evidence-based approach for treating PHN that was not available until very recently. In randomised, controlled clinical trials, the topical lidocaine patch, gabapentin, and controlled release oxycodone have been shown to provide superior pain relief in patients with PHN when compared with placebo. It has also recently been demonstrated that the tricyclic antidepressant nortriptyline provides equivalent analgesic benefit when compared with amitriptyline, but is better tolerated. Based on these results, nortriptyline can now be considered the preferred antidepressant for the treatment of PHN, although desipramine may be used if the patient experiences unacceptable sedation from nortriptyline. The topical lidocaine patch, gabapentin and controlled release oxycodone all appear to be as effective as tricyclic antidepressants in the treatment of patients with PHN, and the results of these recent studies suggest that each of these treatments should be considered early in the course of treatment. Additional controlled trials are needed to compare the efficacy and tolerability of these 4 treatments- tricyclic antidepressants, gabapentin, the topical lidocaine patch and controlled release opioid analgesics--used singly and in various combinations in the treatment of patients with PHN.     

Tongue strength: Part II: In artificial alaryngeal speech

Tongue strength does not appear to be reduced in proficient esophageal speakers. However, no data exist on tongue strength for laryngectomized subjects who have not developed esophageal speech. Anterior and lateral tongue strength measures were obtained from 13 laryngectomized subjects who used an artificial larynx and 15 normal subjects by means of a pressure transducer and recording device. The results indicated that laryngectomized subjects had significantly weaker tongues in two of three directions measured. It was concluded that laryngectomy may affect tongue strength, but that the method of alaryngeal speech utilized postoperatively influences the return to normal.