Encircling guidewire facilitates complete excision of image-localized breast lesions

BACKGROUND: An innovative encircling guidewire defines three sides of a target lesion with a single puncture to achieve negative margins. METHODS: Twenty-five patients requiring image-guided surgery were localized with an encircling guidewire. Although the deployed wire is circular, it is straight when placed, using a straight outer needle. After image-guided placement of the wire around the lesion, all patients underwent standard surgical excision. Each patient was categorized by proper localization of the target lesion, presence of negative margins, closest margin, and need for reexcision. RESULTS: The circlewire wire identified the target lesion in all cases. There were no complications relative to either version of the leading tip on the guidewire. Negative margins were achieved in all pure invasive ductal carcinomas. Positive margins were found in all 3 patients with extensive noncalcified in-situ disease and 1 patient with multifocal invasive lobular carcinoma. CONCLUSIONS: An innovative encircling localizing guidewire device gives the surgeon a new option to completely remove a nonpalpable breast lesion.     

Phase III quality-of-life study results: impact on patients' quality of life to reducing xerostomia after radiotherapy for head-and-neck cancer--RTOG 97-09

PURPOSE: To determine whether prevention of hyposalivation after curative radiotherapy (RT) to the head and neck improves patients' quality of life (QOL). METHODS AND MATERIALS: Patients were to receive at least 50 Gy to 50% of the volume of the major salivary glands, provide unstimulated and stimulated saliva samples, and complete the University of Washington head-and-neck QOL tool before RT and 3 and 6 months after RT. Patients were randomized to receive pilocarpine 5 mg or placebo q.i.d. RESULTS: A total of 249 patients was randomized between March 1998 and January 2000. Of these, 214 were eligible for QOL analysis. Patients were evenly distributed between arms by race, gender, tobacco use, tumor site, T stage (50% T2-T3), and salivary function. A Karnofsky performance status of 90% was more common in the pilocarpine arm. Twenty percent of the patients on the pilocarpine arm and 29% of the patients on the placebo arm were taking nutritional supplements. The placebo arm patients had greater mouth pain and chewing difficulties. Compliance for the QOL tool at 3 and 6 months was 65% and 50%, respectively. Despite statistically significant (p = 0.047 and p = 0.049, respectively) preservation of salivary function in the pilocarpine arm, patients on the pilocarpine arm reported difficulties with swallowing (75%), activity (80%), hyposalivation (64%), and taste (81%). No difference was noted between arms at 3 months in mucositis scores, with both arms demonstrating increased requirement for oral nutrients. CONCLUSION: Objective prevention of hyposalivation did not affect patients' assessment of salivary function or QOL because of the greater impact mucositis plays in QOL after RT.     

Temperature rise due to finishing of direct restorative materials

An in vitro study was performed to evaluate the effect of four variables on the temperature rise produced by the finishing of restorations. The four variables were: restorative material, finishing agent, finishing time, and depth of dentin under the restoration. Class V preparations were cut on extracted premolars and restored with amalgam, composite, or glass ionomer cement. Finishing was done with wet pumice and cup, wet pumice and a brush, a grit rubber polishing point, and an aluminum oxide- coated disc. Finishing time was continuous or intermittent for up to 1 minute. Dentin thickness under the restoration was 0.5 mm to 3.0 mm. Amalgam produced the highest temperature rises at the pulp, while composite and glass ionomer were no different than the untreated (virgin) tooth. Aluminum oxide discs produced the largest temperature rise, wet pumice with a brush the least. Temperature rise increased almost linearly with continuous finishing, while intermittent finishing significantly reduced temperature rise in all cases. Thickness of remaining dentin was only significant for the amalgam restoration, and then only at 1.0 and 0.5 mm.     

Self efficacy for fruit,vegetable and water intakes: Expanded and abbreviated scales from item response modeling analyses

Objective  

To improve an existing measure of fruit and vegetable intake self efficacy by including items that varied on levels of difficulty, and testing a corresponding measure of water intake self efficacy.     

The University Hospital Nurse Extender Model. Part II, Program implementation

This second article in a four-part series provides a detailed discussion of each phase of the implementation process, along with a demographic summary of the University Hospital Patient Care Technicians' Program 2 years after program implementation. Part I provided the overview and conceptual framework for the model. Parts III and IV will present the results of a year-long evaluation of the model and the lessons learned during the implementation process.     

Understanding the Links Among School Misbehavior,Academic Achievement,and Cigarette Use: A National Panel Study of Adolescents

Relations among academic achievement, school bonding, school misbehavior, and cigarette use from 8th to 12th grade were examined in two national panel samples of youth (n = 3056). A series of competing conceptual models developed a priori was tested using structural equation modeling (SEM). The findings suggest that during middle adolescence the predominant direction of influence is from school experiences to cigarette use. School misbehavior and low academic achievement contribute to increased cigarette use over time both directly and indirectly. Two-group SEM analyses involving two cohorts—gender and ethnicity—revealed that our findings are robust. In addition, comparisons between high school dropouts and nondropouts and between eighth-grade cigarette use initiators and nonusers revealed few differences in direction or magnitude of effects. Results suggest that prevention programs that attempt to reduce school misbehavior and academic failure, as well as to help students who misbehave and have difficulty in school constructively avoid negative school- and health-related outcomes, are likely to be effective in reducing adolescent cigarette use.     

The Health of Teenagers: A Focused Ethnographic Study

This study, a focused community analysis, was conducted to determine the health needs and status of the aggregate of school-aged adolescents (13–18 years) using a method combining an epidemiologic approach with an ethnographic field method. Health was defined broadly, assumed to be interrelated with environmental, economic, social, educational, and cultural variables influencing adolescent life. The research involved five steps: collection of available secondary epidemiologic and census data; interviews with key informants, such as teachers, parents, school nurses, and other adults working with teenagers; participant observation and ethnographic interviews with primary informants, that is, teenagers from a variety of backgrounds; and finally, analysis and reporting of secondary and ethnographic data. Of the many themes generated in the data collection, four are reported here: lifestyle, health, pregnancy, and substance abuse. Findings included a typology of subgroups of the adolescent population that influenced lifestyles and led to different attitudes toward health, pregnancy, and substance abuse. The ethnographic approach facilitated an understanding of the health needs and attitudes of teenagers, implying a need for altered interventions and approaches by adults teaching and caring for them.