The scientific rationale and development of an optimized dentifrice for the treatment of dentin hypersensitivity

PURPOSE: To describe the development of a new dentin hypersensitivity treatment, Colgate Sensitive Maximum Strength dentifrice, containing 5% potassium nitrate as the anti-hypersensitivity active agent. The objective was to develop a home-use hypersensitivity dentifrice that would be superior to the market leader, improving on what is available, which also contains 5% potassium nitrate as the anti-hypersensitivity active agent. METHODS: In vivo (clinicals, taste evaluation and rat caries), in vitro (potassium flux) and analytical (rheology, dispensed volume, scanning electron microscopy, electron scanning chemical analysis and radioactive dentin abrasion) methods were performed. RESULTS: The objective was accomplished with the development of a new activated silica technology that resulted in enhanced potassium ion activity. In vitro documentation, supported by clinical studies, demonstrated that the resulting formula is more effective than the market leader for relief of hypersensitivity pain. Fast pain relief in less than 2 weeks and long-lasting protection against pain with regular use have also been clinically documented. Furthermore, FDA-required in vivo and in vitro studies indicate that this formula, which contains 0.45% stannous fluoride (1100 ppm fluoride) as the anti-caries active agent, is effective against caries. Good taste, acceptable rheology, acceptable abrasivity, and cosmetic and chemical stability have all been engineered into this unique dentin hypersensitivity treatment. In summary, a highly efficacious consumer friendly treatment for dentin hypersensitivity has been developed.     

2003 National MCH Epidemiology Awards: Recognizing Excellence

Maternal and Child Health Journal -     

A review of perineal skin care protocols and skin barrier product use

Perineal skin damage secondary to incontinence is painful, prevalent, and preventable. Skin care professionals consider regular application of skin protectants for patients with incontinence the standard of care for preventing perineal skin injury secondary to incontinence. Although protocols to improve care exist, the extent to which they are implemented and followed has not been documented. A study was conducted to ascertain the extent to which perineal skin care protocols are consistent with Wound, Ostomy and Continence Nurses Society Clinical Practice Guidelines and to estimate the level of compliance related to the use of protective perineal skin barriers. A convenience sample of 76 perineal skin care protocols was obtained from acute care (n = 55), long-term care (n = 9), and nondisclosed types of extended care facilities (n = 12). All protocol interventions were compared to the Wound, Ostomy and Continence Nurses guidelines. Healthcare Products Information Services data were used to obtain the total amount of skin protectants sold to US healthcare facilities in 2002. Skin protectant use was compared to previously published urinary and fecal (urofecal) incontinence prevalence data. All 76 protocols lacked one or more of the interventions considered important in perineal skin care. Although 75% of the protocols included the use of skin protectants, Healthcare Products Information Services data and urofecal prevalence data suggest underutilization of skin protectants; an estimated 10 cents per day versus an anticipated average cost of 23.5 cents per application is being spent. Further study is warranted and necessary to ensure the application of evidence-based protocols of care in practice.     

In vitro investigation of voriconazole susceptibility for keratitis and endophthalmitis fungal pathogens

PURPOSE: To update the spectrum of ocular fungal isolates and investigate the in vitro efficacy of voriconazole and other antifungals. DESIGN: Experimental study. METHODS: Microbiology database was scanned and fungal isolates associated with keratitis (419) and endophthalmitis (122) were analyzed for classification and isolate frequency. The Sensititre YeastOne microdilution antifungal susceptibility test was used to evaluate susceptibility (MICs) of 34 common fungal pathogens against amphotericin B, fluconazole, ketoconazole, 5-flucytosine, itraconazole, and voriconazole. Ten of the test isolates were sent to a reference laboratory to validate the Sensititre results. RESULTS: Fusarium species remains the most frequent corneal fungal pathogen (60.1%). Colletotrichum species (4.1%) has emerged as the fifth most common mold in keratitis. Top yeast isolates from cornea included Candida albicans (52.3%) and Candida parapsilosis (37.3%). Half of the intraocular pathogens were Candida species. Paecilomyces (2.9%) and Philophora (1.9) were unusual pathogens. In vitro susceptibility profiles were voriconazole (100%), ketoconazole (82.4%), amphotericin (76.5%), itraconazole (67%), fluconazole (60%), and 5-FC (60%). Voriconazole MIC(90) were lowest for Candida species (0.016 microg/ml) and highest for Fusarium species (2 microg/ml). Reference laboratory MICs correlated 100% for yeast isolates (0.016 microg/ml) but were fourfold higher for Fusarium species (8 microg/ml). MIC(90) for Aspergillus species was 0.5 microg/ml. CONCLUSIONS: Candida, Fusarium, and Aspergillus species remain frequent fungal pathogens. Voriconazole may have a role in the therapeutic management of Candida and Aspergillus ocular infections. Clinical efficacy must determine the role for other fungal pathogens. Human use and animal models will determine its use in the clinical setting.     

Pathologically proven cavernous angiomas of the brain following radiation therapy for pediatric brain tumors

Lesions consistent with cavernous angiomas (CAs) of the brain are sometimes seen on MRI scans of the brains of patients who received radiation therapy for brain tumors as children. The lesions appear years later within brain tissue that was included in radiation fields. It is unclear whether these MRI-detected lesions are true CAs or a pathological variant. This study reports the clinical, radiographical, and pathological findings in 3 cases of radiation-induced CAs of the brain. From 1995 to 1997, 3 patients previously treated with radiation therapy (45-55 Gy) for pediatric brain tumors (medulloblastoma, ependymoma, and a presumed midbrain astrocytoma) underwent resections of symptomatic and enlarging lesions that were consistent with a CA of the brain. All of the lesions occurred within fields of prior irradiation. None of the patients had received chemotherapy as part of their cancer treatment. CA-presenting symptoms included seizures, cranial nerve deficits, and headaches. The lesions appeared 7-19 years after radiation therapy and slowly enlarged on subsequent imaging studies. MRI scans of the lesions revealed characteristics typical of CA. The lesions became symptomatic 1-5 years after they were initially noted. Surgical resection was performed 1-2 years after symptoms began. The age at resection ranged from 15 to 23 years (10-21 years after radiation therapy). Pathological analysis of the three lesions showed typical CA characteristics. Some CAs may be caused by radiation therapy for pediatric brain tumors. They are radiologically and pathologically similar to sporadically occurring CAs of the brain and may enlarge over time and become symptomatic. CAs can be safely resected using standard microsurgical techniques.     

Can we talk? Developing a social support nursing intervention for couples

Social support is an important influence on success during lifestyle modification attempts. According to the theory of expressed emotion, support that is perceived by the recipient as critical or overprotective is unhelpful and perhaps harmful. This article describes an intervention for couples and preliminary assessment of its feasibility and acceptability by the nurses who trialed it. Four staff nurses and 2 advanced practice nurses administered the intervention to 15 couples and reported on the benefits and limitations of the intervention. One individual in each couple had a chronic or an acute cardiac illness. The nurses perceived the intervention as valuable; even a single session stimulated discussion between the couple about important issues. Complexity, logistic barriers, and time constraints limited the technique. The authors conclude that this intervention may be most useful to clinical nurse specialists who have additional education, training in communication, and teaching and consulting skills.