Using a standardized assessment tool to measure patient experience on a seizure monitoring unit compared to a general neurology unit

Seizure monitoring unit (SMU) research typically focuses on diagnostic utility and medical management of epilepsy. However, patient safety and satisfaction are also imperative to high-quality SMU care. This study uses a standardized tool to evaluate patient experience on a SMU compared to a general neurology unit (GNU). The 27-item Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was telephone-administered post-discharge to a sample of patients from our SMU and GNU. Data from a 33-month period were reviewed, encompassing 217 SMU patient admissions and 317 GNU patient admissions. On average, SMU patients were 14.7 years younger and stayed in the hospital 4.2 days longer than GNU patients. SMU patients provided lower overall mental health ratings (p<.001), perceived nursing staff to be more responsive to the call button (p<.001), and assigned higher overall ratings to their stay (p<0.05). Lower education was associated with more favorable hospital ratings on both units (p<0.05).     

Experience and satisfaction of staff working in a seizure monitoring unit

The purpose of this study was to investigate staff experience and satisfaction in the seizure monitoring unit (SMU) of a large health region serving a population of 1.4 million. A staff satisfaction questionnaire was administered yearly between 2007 and 2010 with an average response rate of 58.4%. The majority of staff perceived the SMU to be a positive workplace. Strengths of the SMU were interdisciplinary teamwork and patient-centred care. Satisfaction with professional development opportunities increased from 2007 to 2010, likely reflecting the implementation of training sessions. The physical environment was the least satisfactory. This study highlights aspects of staff experience that have improved or still need to be improved since implementing a quality and safety program in our SMU.     

Association between resting energy expenditure,psychopathology and HPA-axis in eating disorders

AIM: To investigate the complex relationships between resting energy expenditure (REE), eating psychopathology, and Hypothalamus Pituitary Adrenal axis functioning in patients with eating disorders.METHODS: The study was designed as a cross-sectional survey, and it was planned by the Clinic for Eating Disorders of the University of Florence (Italy). The protocol was approved by the Ethics Committee of the Institution. Twenty two anorexia nervosa and twenty one Bulimia Nervosa patients were assessed by means of a clinical interview and the structured clinical interview for diagnostic and statistical manual of mental disorders, fourth edition. Eating attitudes and behaviour were specifically investigated by means of the eating disorder examination questionnaire (EDE-Q). Patients were also evaluated by means of the symptom checklist (SCL 90-R), REE was measured by means of indirect calorimetry, and blood cortisol morning levels were evaluated.RESULTS: Both anorexia nervosa and bulimia nervosa patients showed a reduced REE as compared with predicted REE. Body mass index (BMI) was positively associated with resting energy expenditure in Bulimics, whereas a strong, negative association between BMI and REE was observed in Anorectics. The pattern of associations between variables supported a mediation model, where shape concern accounted for variations in REE and cortisol levels (mediator), and variations in the mediator significantly accounted for variations in REE. When these associations where taken into account together, the relationship between shape concern and REE was no longer significant, whereas the association between cortisol levels and REE retained its significance, showing strong evidence for a single, dominant mediator. Anorectics and Bulimics showed an opposite pattern of association between BMI and REE. In Anorectics only, a higher REE was associated with a more severe eating disorder specific psychopathology, and cortisol levels represent a possible mediating factor for this relationship.CONCLUSION: The data supported a mediation model where cortisol levels mediated the relationship between eating psychopathology (concern about body shape) and REE.     

Prediction of coronary artery plaque progression and potential rupture from 320-detector row prospectively ECG-gated single heart beat CT angiography: Lattice Boltzmann evaluation of endothelial shear stress

Advances in MDCT will extend coronary CTA beyond the morphology data provided by systems that use 64 or fewer detector rows. Newer coronary CTA technology such as prospective ECG-gating will also enable lower dose examinations. Since the current standard of care for coronary diagnoses is catheterization, CT will continue to be benchmarked against catheterization reference points, in particular temporal resolution, spatial resolution, radiation dose, and volume coverage. This article focuses on single heart beat cardiac acquisitions enabled by 320-detector row CT. Imaging with this system can now be performed with patient radiation doses comparable to catheterization. The high image quality, excellent contrast opacification, and absence of stair-step artifact provide the potential to evaluate endothelial shear stress (ESS) noninvasively with CT. Low ESS is known to lead to the development and progression of atherosclerotic plaque culminating in high-risk vulnerable plaque likely to rupture and cause an acute coronary event. The magnitude of local low ESS, in combination with the local remodeling response and the severity of systemic risk factors, determines the natural history of each plaque. This paper describes the steps required to derive an ESS map from 320-detector row CT data using the Lattice Boltzmann method to include the complex geometry of the coronary arterial tree. This approach diminishes the limitations of other computational fluid dynamics methods to properly evaluate multiple coronary arteries, including the complex geometry of coronary bifurcations where lesions tend to develop.     

Influence of the hydrostatic pulpal pressure on droplets formation in current etch-and-rinse and self-etch adhesives: A video rate/TSM microscopy and fluid filtration study

ObjectivesThe aim of this study was to investigate the droplet formation using a real-time/confocal microscopy technique, when different self-etching and etch-and-rinse adhesives were applied in the presence or absence of pulpal pressure. Resin–dentin permeability (%P) was also evaluated.MethodsOptibond FL, Silorane adhesive, Scotchbond 1XT, G-Bond and DC-Bond were bonded in the presence or in absence of simulated pulpal pressure. A fluid-transport model was used to measure the water permeability through resin-bonded dentin. Half of the specimens bonded in the presence of the hydrostatic pulpal pressure (20 cm H₂O) were light cured, whereas the remnant half received no light curing. The same was done with the half of the specimens bonded under no pulpal pressure. The specimens were investigated under a confocal TSM.ResultsOptibond FL and G-Bond had the lowest dentin permeability. Optibond FL adhesive showed few water droplets on the polymerized external surface and within the resin–dentin interface. G-Bond showed static interfacial globular-like droplet formation. DC-Bond and Scotchbond 1XT were the most water permeable adhesives both in the presence and in absence of pulpal pressure. A dynamic interfacial non-globular-like droplet formation was observed. Severe droplet formation was observed on the polymerized external surface.SignificanceThe presence of the pulpal pressure may cause increasing in fluid filtration and droplet formation in simplified adhesives containing HEMA. The adhesives containing 4-META (G-Bond) may be affected by static phase separation but by very low osmotic droplets formation and water permeability. The three-step adhesives are less affected by these problems.     

Micro-computed tomography of tooth tissue volume changes following endodontic procedures and post space preparation

Aim  To compare the volume of hard tooth tissue lost after caries removal, access cavity preparation, root canal preparation, fibre post space and cast post preparation in carious premolar teeth. The null hypothesis tested was that there is no difference between the volumes of hard tooth tissue lost expressed as a percentage of the preoperative hard tooth tissue volume, after each operative procedure.
Methodology  Twelve extracted human premolars with mesial or distal carious cavities penetrating into the pulp chamber were selected. Teeth were scanned using a microCT scanner. After each operative procedure the loss of hard tooth tissue volume was measured. The data were statistically analysed using one-way analysis of variance and Fisher's PLSD test with statistical significance set at α = 0.01.
Results  The percentage of preoperative hard tooth tissue volume lost after caries removal was 8.3 ± 5.83, after access cavity preparation the loss of volume reached 12.7 ± 6.7% (increase of 4.4%). After root canal preparation, fibre post space and cast post preparation the hard tissue volume lost reached, 13.7 ± 6.7 (increase of 1%), 15.1 ± 6.3 (increase of 1.4%) and 19.2 ± 7.4 (increase of 4.1%) respectively. Each procedure performed after caries removal significantly increased ( P  < 0.01) the amount of hard tissue volume lost with the exception of the root canal preparation.
Conclusions  Access cavity and post space preparation are the procedures during root canal treatment which result in the largest loss of hard tooth tissue structure. Cast post space preparation causes a larger loss of tooth structure than fibre post space preparation. This should be taken into account when planning root canal treatment and restoration of root filled teeth that are to be restored with cuspal coverage restorations.     

In situ enamel morphology evaluation after acidic soft drink consumption: protection factor of contemporary toothpaste

Abstract: Objective: The enamel erosion induced by acidic soft drinks is an increasingly important problem. The aim of this study was to investigate the effect of soft drinks on enamel erosion and the protection offered by representative modern toothpastes using a new ‘in situ scanning electron microscopy (SEM)‐replica technique’. Methods: Six patients were selected to receive in vivo enamel replicas, fabricated with a polyvinyl‐siloxane/polyether impression material. Scanning electron microscopy was used to evaluate the morphology of enamel surface before and after exposure to lemon juice and SPRITE^®. The protective effectiveness of toothpaste was further evaluated with the same method. Furthermore, to validate the effectiveness of the in situ SEM‐replica technique, we compared it to a direct in vitro SEM investigation on extracted teeth. Results: Scanning electron microscopy investigation of the in situ replicas showed severe enamel morphology alterations after acidic soft drink exposure. On the other hand, it was also showed the protective effectiveness of toothpaste in preventing enamel erosion induced by acidic soft drinks. The direct in vitro SEM investigation provided similar enamel erosion results and proved the effectiveness of the in situ SEM‐replica technique. Conclusion: Acidic soft drinks induce enamel erosion but regular use of toothpaste might reduce the risk for enamel erosion. The in situ SEM‐replica technique provides an accurate method for tracing enamel morphology alterations and erosion induced by acidic soft drinks.     

Detection of CD34, TdT, CD56, CD2, CD4, and CD14 by flow cytometry is associated with NPM1 and FLT3 mutation status in cytogenetically normal acute myeloid leukemia

MethodsWe retrospectively correlated NPM1 and FLT3 mutation status with flow cytometric profile of leukemic blasts in 83 adult patients with cytogenetically normal acute myeloid leukemia (CN-AML).ResultsMutation of the NPM1 gene (NPM1.mt) was found in 39 (47%) of 83 patients, and internal tandem duplication (ITD) of the FLT3 gene (FLT3-ITD) was seen in 38 (46%) of 83 patients. Patients with CN-AML and with NPM1.mt were less likely to express CD34 (33% vs. 93%; 2P = .0001), CD2 (0% vs. 14%; 2P = .0187), and CD14 (6% vs. 22%, 2P = .0476), and were more likely to express CD4 (65.5% vs. 37%; 2P = .0367) and CD19 (49% vs. 27%; 2P = .0506). The patients with CN-AML and with FLT3-ITD were more likely to express CD56 (47% vs. 23%; 2P = .0393). Moreover, patients with favorable prognostic combination of NPM1.mt and wild-type (wt) FLT3 (n = 18) were less likely to express CD34 (33% vs. 74% all others; 2P = .0021) and CD56 (6% vs. 37% all others; 2P = .0072). The group with an unfavorable prognostic combination of NPM1-wt and FLT3-ITD (n = 17) were more likely to express CD34 (88% vs. 45% all others; 2P = .0011) and TdT (40% vs. 2% all others; 2P = .0054).ConclusionsIn patients with CN-AML, characteristic flow cytometric profile is associated with NPM1 and FLT3 mutation status.