The Test of Orientation for Rehabilitation Patients: interrater reliability

The Test of Orientation for Rehabilitation Patients (TORP) (Deitz, Beeman, & Thorn, in press) was developed for use with patients with brain injuries in inpatient rehabilitation settings. It was designed to assess orientation to person and personal situation, place, time, schedule, and temporal continuity. Interrater reliability for the TORP was examined with the use of 34 brain-injured and 35 non-brain-injured patients. Two occupational therapists trained in administering the TORP, as specified in the test manual (Dietz et al., in press), served as the examiners. One therapist administered and scored the test while the second therapist observed and scored the test for the same subject. Intraclass correlation coefficients, used as indexes of reliability for the scoring of the total test and subtests, ranged from .89 to 1.00 for the non-brain-injured group and from .94 to .99 for the brain-injured group. These findings suggest that an occupational therapist can reliably score the TORP for patients both with and without brain injuries.     

MGB1 Poor Adherence to Hypertension Treatment Guidelines: An Analysis of Therapeutic Choices

The recent Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) reiterated long-standing recommendations that Stage 1 hypertension (BP ≥ 140/90 mm Hg) without comorbidity should be treated initially with diuretics (DI) or beta blockers (BB). Yet market research suggests that many physicians prefer to use other drug classes, such as calcium channel blockers and ACE inhibitors.
OBJECTIVES: To explore the determinants of therapeutic choice in hypertension.
METHODS: We surveyed by mail a stratified random sample of 10,000 U.S. cardiologists, internists, and family/general practitioners. Physicians were queried about their practice environment and their knowledge, attitudes, and practices regarding antihypertensive therapy, including their choice of drugs to treat patients with specified clinical profiles. The probability that physicians would follow JNC guidelines Stage 1 hypertension was analyzed using multiple logistic regression with stepwise backward elimination to select variable with p < 0.001.
RESULTS: Completed surveys were received from 1,023 physicians. 86.7% prescribe drug therapy for Stage 1 hypertension, and 19.5% (22.5% of drug prescribers) limit their choices to DI and BB. Guideline conformity was higher among physicians who: practice in academic medical centrers; are older; are general practitioners (versus general internists); have smaller caseloads; have fewer hypertensive patients; have higher proportions of HMO, Medicaid, and uninsured patients; and experience more formulary restrictions. Cardiologists and family practitioners were less likely than internists to follow guidelines.
CONCLUSION: JNC guidelines are better accepted by academic physicians, older physicians who have more expenence using DI and BB, physicians with smaller caseloads and hence more time for follow-up and therapy adjustment, and physicians who face drug reimbursement constraints.     

Third molar management: a case for routine removal in adolescent and young adult orthodontic patients.

The role of the orthodontist is to treat patients to optimal function, aesthetics, and long-term stability. The controversy surrounding third molars has focused on the pathologic problems they may cause and the risk/benefits of their removal. Although malocclusion is not considered a disease, it is unreasonable to ignore the orthodontic issues related to third molars, especially in patients who make the investment to achieve an ideal occlusion. Part of a complete orthodontic treatment plan is a recommendation regarding third molars. The plan should include a rationale and recommendation for their removal based on the orthodontic treatment objectives.     

Demography of sleep disturbances associated with circadian rhythm disorders in Japan

To clarify the demography of delayed sleep phase syndrome (DSPS), non-24-h sleep-wake syndrome, and irregular sleep-wake pattern in Japan, a cross-sectional nationwide epidemiological survey was conducted. 1525 adults (age: 15-59 years) were randomly sampled from telephone directories, and they received screening questions over the phone. Persons who were suspected of having the disorders were requested to fill out the second questionnaire, and asked to keep a sleep log for 4 weeks. Diagnoses were made according to the International Classification of Sleep Disorders criteria. As a result, the prevalence of DSPS was estimated to be 0.13%.     

An Audit of the Activities of the Pediatric Dermatology Nurse Specialist (PDNS)

Abstract:   In the current financial climate where resources in the National Health Service are becoming increasingly limited, it is essential that the role of the pediatric dermatology nurse specialist remains appreciated and supported. Our pediatric dermatology nurse specialist was first employed in September 2002 having had 6 years experience nursing children with a wide variety of dermatologic conditions prior to her employment. She achieved her pediatric community nursing degree in 2003 undertaking the nurse prescribing extended formulary course in 2006, her training history representative of many nurse specialists. We present the results of an audit highlighting how the employment of our pediatric dermatology nurse specialist has led to a decrease in hospital admissions as well as providing a significant positive impact on waiting lists.