Congenital pineoblastoma in the newborn: ultrasound evaluation

Transfontanelle, real-time ultrasound (US) examinations were performed in two newborn infants with congenital pineoblastoma. The tumors were hyperechoic relative to the surrounding cerebral tissue. Both were midline lesions that abutted on the posterior portion of the third ventricle, causing obstructive hydrocephalus. The US findings were correlated with CT, pathologic examination, and clinical follow-up study.     

Effects of an environmental manipulation emphasizing client-centred care on agitation and sleep in dementia sufferers in a nursing home

This study was designed to determine whether a change from a task-oriented care approach to a client-oriented care approach affects (a) the level of agitation and (b) 24-hour sleep in residents suffering from dementia in a nursing home The levels of dementia and sleep of 33 nursing home residents were measured four times over 12 weeks (twice before and twice after the change in care approach) using the Cohen-Mansfield agitation inventory and the dementia mood assessment scale Verbal agitation levels significantly decreased 6 to 8 weeks following the change, whereas more infrequent agitated behaviours, which were classified as 'other', significantly increased Daytime sleep increased initially after the change but then returned to baseline levels after 6 weeks While the main focus of the study was on residents 'behaviour following an environmental manipulation, anecdotal observations of staff members interactions with residents indicated that they felt less rushed and were more tolerant of residents' behaviour following the intervention     

Comparing outcomes in renal replacement therapy: how should we correct for case mix?

The need to evaluate the effectiveness of clinical practice to justify expensive therapy in the face of financial constraints in all areas of health care delivery makes it necessary to identify groups of patients who are likely to benefit most from treatment. Various risk stratification methods have been used for analyzing survival probabilities for patients receiving renal replacement therapy. Complicated risk stratification methods produce large numbers of risk groups of small sizes, which makes comparison between individual centers difficult. We compared three simple methods of risk stratification, that divided patients into low-, medium-, and high-risk groups, in a cohort of 1,407 patients who commenced renal replacement therapy in five European countries during a 7-year period. Method 1 considered age (>55 years) and diabetes alone; method 2 used a higher age limit (>70 years) and comorbid illnesses, including those other than diabetes; and method 3 used only the number of comorbidities (none, 1, or > or =2) for stratification. Kaplan-Meier survival curves were constructed for comparison between risk groups and Cox's regression model used to assess strength of relationship with mortality. Although patient survival was significantly different between the low-, medium-, and high-risk groups using all three methods, Cox's regression analysis showed that method 2 provided the greatest discrimination between risk groups. In predicting mortality, method 2 (based on comorbidities and age) showed the highest sensitivity and specificity (84% and 80%, respectively) compared with method 1 (80% and 74%) and method 3 (64% and 82%). Validation of this approach in other populations in a prospective study is required before this method, which takes into account the influences of both age and comorbidity for risk stratification, can be used for comparing survival data and for presenting results of renal replacement therapy.     

Evaluation of a tactile hardness test in indirect pulp capping

Summary. The value of a tactile hardness test in indirect pulp capping was investigated by comparing hardness values with the biochemical analysis for phosphorus. Statistically significant differences were found between the 6-month evaluation groups recorded as soft or medium and those recorded as hard. However, there were no differences between groups evaluated as soft or medium before or after treatment.