Biobrane versus duoderm for the treatment of intermediate thickness burns in children: a prospective, randomized trial

In this study, we directly compared the efficacy of Biobrane and Duoderm for the treatment of small intermediate thickness burns in children in a prospective, randomized fashion to determine their relative impact on wound healing, pain scores, and cost. Patients under 18 years of age with intermediate thickness burns on a surface area less than 10% were enrolled and treated with one of the two dressing systems. Data collected included mechanism of injury, time to complete healing, pain scores, and institutional cost of materials until healing was complete. No significant difference in time to healing or pain scores was detected between the two groups. The cost of each treatment was statistically more expensive in the Biobrane group. The results of this study demonstrate that Duoderm and Biobrane provide equally effective treatment of partial thickness burns among in the pediatric population. However, Duoderm is statistically less expensive than Biobrane and can be considered a first-line treatment option for intermediate thickness burn wounds in children.     

The double contrast barium enema: improvements to lateral decubitus views including the use of a wedge filter

The prognostic importance of early detection of colonic carcinoma is emphasised and the contribution of an accurate barium enema technique is stressed. Horizontal beam lateral decubitus films are routine in double contrast barium enemas, and it is still common practice in many departments to support the cassette for these views either in the bucky tray or with sandbags. The lateral decubitus views of 100 patients using these methods of cassette support were reviewed. A large number of the films (67%) were technically so unsatisfactory due to unilateral under- or over-penetration that they did not provide acceptable visualisation of the colon. The cause of these technical faults, and the methods by which they may be overcome, are described. In addition, a wedge filter was designed to reduce the absorption by dependent soft tissues in obese patients.     

A statistical review of 100 consecutive "U.C.I." low friction knee arthroplasties with analysis of results.

In 100 U.C.I. low friction knee arthroplasties, the primary goal of relief from pain was accomplished in most patients. However, the precise evaluation of the result of a knee arthroplasty can be difficult. Many of the patients who rated good or better within an average follow up time of one year had patellofemoral complaints to some extent. Cold flow deformation and prosthetic loosening is a definite concern about the tibial component. A longer follow-up study is needed to better evaluate the significance of the 1-2 mm radiolucent line at the bone cement interface of the tibial component. Although most patients in this series were greatly relieved of their pain, even better results are possible if the arthroplasty would include the patellofemoral joint and tibial component more substantially bonded to cancellous bone.     

Tube feeding, antibiotics, and hospitalization of nursing home residents with end-stage dementia: Perceptions of key medical decision-makers

This article discusses the literature supporting the limited use of tube feeding, antibiotics, and hospital transfers of nursing home residents with end-stage dementia. This article also presents the findings of a study that queried 138 nursing home social service staff members in New York State regarding positions taken by key medical decision makers regarding tube feeding, antibiotic use, and hospitalization of nursing home residents with end-stage dementia. Results are discussed in the context of positions taken by experts in palliative and dementia care. According to social service staff perceptions, the majority of these key decision-makers (e.g., administrators, directors of nursing, and medical directors) take positions inconsistent with palliative care experts. Instead, a majority of them were perceived as more likely to encourage tube feeding, antibiotics, and hospitalization of nursing home residents with end-stage dementia. These findings indicate a strong need for educating administrative staff in state-of-the-art care of residents with end-stage dementia.     

A randomized controlled safety and acceptability trial of dextrin sulphate vaginal microbicide gel in sexually active women in Uganda

OBJECTIVE: To assess the safety of dextrin sulphate (DS) gel compared to placebo gel in terms of local and systemic adverse events, and to determine the acceptability of dextrin sulphate gel. DESIGN: A 4-week randomized trial of DS intra-vaginal gel, partially blinded, with placebo and observation control arms. Participants were randomized to use DS gel twice daily, placebo gel twice daily, DS gel pre-sex, or into an observation only arm. METHODS: Sexually active women were recruited from post natal and HIV clinics at Nsambya Hospital, Kampala, Uganda. Screening, enrollment and follow-up visits took place every 1 or 2 weeks over an 8-week period and consisted of questionnaire interviews, colposcopy examinations, sexually transmitted infection screen and routine laboratory testing. RESULTS: Out of a total of 172 women screened, 109 were randomized to use DS gel twice daily (65 women), placebo gel twice daily (15 women), DS gel pre-sex (nine women) or into an observation only arm (20 women). Two individuals had abnormal colposcopy findings in the DS twice daily gel use arm. Vaginal bleeding was reported as frequently by participants in the active gel arm as by participants in the placebo and observation only arms. No clinically significant difference was observed between arms in terms of vaginal flora, Candida, haemoglobin, white cell count, platelets, thrombin time, activated partial thromboplastin time, creatinine and aspartate aminotransferase results after 4 weeks of gel use. DS gel appeared to be acceptable to over 95% of the users. CONCLUSIONS: Results show a satisfactory safety and acceptability profile of dextrin sulphate gel.