The Effect of Botulinum Toxin Type A on Full-Face Intense Pulsed Light Treatment: A Randomized, Double-Blind, Split-Face Study

BACKGROUND Botulinum toxin type A (BTX) is commonly used in combination therapy, and it has been reported that periocular BTX treatment enhances the aesthetic improvements attained with intense pulsed light (IPL).
OBJECTIVE The objective was to evaluate if intradermal BTX treatment of the cheeks also enhances the efficacy of IPL.
METHODS AND MATERIALS Fifteen females enrolled in this prospective, randomized, double-blind, split-face study (14 completed, 1 lost to follow-up). All received standard IPL treatment and were randomly assigned to receive eight 0.1-mL intradermal injections of BTX (BOTOX Cosmetic, Allergan) in one cheek (8 U total dose) and eight injections of saline in the contralateral cheek. Small wrinkles and fine lines, erythema, hyperpigmentation, apparent pore size, skin texture, and overall appearance were evaluated for 8 weeks.
RESULTS A significantly higher proportion of patients showed improvement in small wrinkles and fine lines with IPL plus BTX than IPL plus saline—93% versus 29% at Week 4 ( p =.003). Adjunctive BTX also achieved a greater degree of improvement in erythema (although statistical significance was not achieved). Other efficacy measures showed comparable improvements with both regimens.
CONCLUSION The adjunctive use of BTX enhances the improvement in small wrinkles and fine lines, and possibly erythema, achieved with IPL alone.     

Alternatives for financing health services in Papua New Guinea

Over the past decade the health sector has maintained a budgetshare of over 8% which has accounted for 87.8% of total healthcare financing in Papua New Guinea. Recently, disappointingeconomic performance, and an annual population growth rate of2.3% has led to a decline in the level of government fundingavailable for health. As a result, the government is examiningalternatives for providing the finances needed to maintain theexisting level of health services. This paper quantifies theexpected financial shortfall for funding the recurrent costsof the hearth system. It then discusses the primary alternativesfor filling the resource gap: taxes, user fees, insurance andmission hearth services. Three criteria, feasibility, acceptabilityand coverage, are used to evaluate each of the alternativesgiven the country's political and economic situation.     

Lifestyle behaviours and weight among hospital-based nurses

Aims  The purpose of this study was to (i) describe the weight, weight-related perceptions and lifestyle behaviours of hospital-based nurses, and (ii) explore the relationship of demographic, health, weight and job characteristics with lifestyle behaviours.
Background  The obesity epidemic is widely documented. Worksite initiatives have been advocated. Nurses represent an important part of the hospital workforce and serve as role models when caring for patients.
Methods  A sample of 194 nurses from six hospitals participated in anthropometric measurements and self-administered surveys.
Results  The majority of nurses were overweight and obese, and some were not actively involved in weight management behaviours. Self-reported health, diet and physical activity behaviours were low, although variable by gender, age and shift. Reports of co-worker norms supported low levels of healthy behaviours.
Conclusions  Findings reinforce the need to address the hospital environment and culture as well as individual behaviours for obesity control.
Implications for nursing management  Nurse managers have an opportunity to consider interventions that promote a climate favourable to improved health habits by facilitating and supporting healthy lifestyle choices (nutrition and physical activity) and environmental changes. Such efforts have the potential to increase productivity and morale and decrease work-related disabilities and improve quality of life.     

Cost, Correlates and Effects of Malpractice Litigation in Family Practice Residency Programmes in the United States

A survey of family practice residency programme directors inthe United States was undertaken to look at the impact of malpracticeand malpractice insurance on residency education. Of 385 programmes276 (71.7%) responded to the 20 question survey. The resultsindicated a mean rate of 0.043 claims per resident or facultymember in the previous year. One-fifth of the respondents didnot report the type of malpractice insurance retained for residentsand over half did not report the cost of insurance for residents.Current problems with liability were most often related to theregion of the country, number of visits to the family practicecentre, the number of residents, the number of faculty, thetype of faculty employer and the type of resident employer.Programmes which anticipated future problems with liabilitywere most likely to be those with current problems. The areasidentified as most concerning to residents included: obstetrics,cost of malpractice insurance, difficulty obtaining coverage,and the general anxiety created by malpractice litigation.     

Right Side Implant of the Unipolar Single Lead Defihrillation System

The active can defibrillator has been designed for implantation in the left prepectoral region. Whether this system can be successfully implanted on the right side is unknown. We describe six cases in which placement of the unipolar single lead defibrillation system was successfully attempted in the right prepectoral region due to impediments on the left side. The mean age of the patients was 62 ± 12 years. Five patients had is–chemic heart disease and one idiopathic dilated cardiomyopathy. The endocardial defibrillation electrode was placed in the right ventricle through the right subclavian vein and positioned at the apex in two patients and in the septal position in four patients. Defibrillation threshold testing was performed using a step-up/step-down protocol beginning at 12 J with 3-J increments or decrements. Defibrillation threshold was defined as the lowest energy of the first shock able to terminate ventricular fibrillation. The generator models used were the Medtronic 7218C in 1 patient, the Medtronic 7219C in 3 patients, and the Ventritex Cadet 115 AC in 2 patients. The mean defibrillation threshold was 15 ± 3 J. The defibrillation thresholds were retested at 1,3, and 6 months, and showed no significant change in five patients but decreased from 15 J to 12 J in one patient. The presence of impediments on the left side should not preclude attempts to place the unipolar active can system in the right prepectoral region.     

Immune-mediated adherence of eosinophils to Toxocara canis infective larvae: the role of excretory-secretory antigens

The participation of Toxocara canis larval excretory-secretory antigens in immune-mediated adherence was determined in vitro. Adsorption of immune sera with excretory-secretory antigens removed some complement components, removed IgG antibody directed against larval surfaces, and abrogated all adherence observed with untreated immune serum. At least four antigens could be implicated in adherence, by Western blot analysis of adherence mediating sera. Scanning and transmission electron microscopic examination of larval-eosinophil interactions revealed that eosinophils adhered to a membranous sheath-like layer that was frequently detached from the larval epicuticle. The layers appeared to be composed of surface antigens and antibody, and may provide larvae with protection against antibody and eosinophil toxins by preventing their contact with the epicuticle. The release of surface antigens also may be important in allowing larvae to evade the host's immune response by facilitating the removal of antibody and eosinophils from the larval surface.     

Persistence of heroin use despite methadone treatment: Poor coping self‐efficacy predicts continued heroin use

Aim. To evaluate the association between coping self‐efficacy and persistent use of heroin by patients enrolled in a methadone treatment program. Design and Methods. Cross‐sectional survey. One hundred and ninety‐one patients attending outpatient methadone clinics in South‐East England, United Kingdom. Validated questionnaires were used to assess drug use (Maudsley Addiction Profile), alcohol use (Alcohol Use Disorders Identification Test), mental health (Hospital Anxiety and Depression Scale) and coping self‐efficacy (brief 8‐item Drug Taking Confidence Questionnaire). Results. Half of the participants (95/191) reported heroin use in the preceding 14‐day period. Heroin use during methadone treatment was associated with financial problems (P = 0.008), spending time with other drug users (P < 0.001), cocaine use (P = 0.002), low mood (P = 0.002) and dissatisfaction with the daily methadone dose (P = 0.014). Compared with ‘Heroin‐abstinent’ patients, the ‘Heroin’ group reported significantly lower mean coping self‐efficacy scores (t = 9.8, d.f. = 182, P < 0.001, effect size 1.17). After correcting for the effects of co‐variants in a logistic regression model, the main determinants of persistent heroin use were ‘coping self‐efficacy’[B ?0.05; standard error (SE) 0.008; Wald 36.6; odds ratio (OR) 0.95, 95% confidence interval (CI) 0.94, 0.97; P < 0.001] and ‘dissatisfaction with methadone dose’ (B 0.93; SE 0.46; Wald 4.1; OR 2.5, 95% CI 1.03, 6.25; P = 0.042). Satisfaction with methadone dose showed no association with self‐efficacy. Discussion and Conclusions. While heroin use during methadone treatment can partly be explained by inadequate dosing, our data suggest a more complex picture with significant contribution from poor coping self‐efficacy. Efforts aimed at enhancing and maintaining the patients' self‐efficacy and social skills are likely to improve heroin and other drug use outcomes with added benefits for treatment completion rates and the throughput of methadone programs.[Senbanjo R, Wolff K, Marshall EJ, Strang J. Persistence of heroin use despite methadone treatment: Poor coping self‐efficacy predicts continued heroin use. Drug Alcohol Rev 2009]     

A randomized controlled trial of sedation in the critically ill

A randomized controlled trial comparing: a) a combination of oral chloral hydrate and promethazine to b) a continuous intravenous midazolam infusion, for maintenance sedation in critically ill children, was carried out. The level of sedation was assessed four hourly using a specifically devized sedation scale. Forty-four children entered the study of whom two were subsequently excluded. The number of satisfactory assessments (desired and actual levels of sedation equal) was significantly greater in the chloral hydrate and promethazine group (Chi-squared P <0.01; confidence intervals of the difference 0.06 to 0.20). The number of assessments at level 5 on the sedation scale (patient restless/distressed) was significantly greater in the midazolam group (Chi-squared P <0.05). The total number of satisfactory assessments in the two groups were only 61 and 48% respectively, suggesting that sedation can be considerably improved. Chloral hydrate and promethazine are more effective than midazolam as maintenance sedation in critically ill children. It is possible to prospectively study the efficacy of sedative drugs in critically ill children.