Appropriate responses by elders to oral symptoms: dentists' recommendations

This paper reports the results of a study of dentists' recommendations regarding the appropriate health action of elders in response to certain oral common symp toms and problems. Previous studies have found that elders most commonly respond to oral symptoms by using nonprofessional means. This study found that, without exception, the recommendation to consult a dentist was the primary mode of response favored by dentists, even in response to symptoms and problems that are most often trivial and rarely indicative of serious health problems. The results of this pilot study suggest that the need exists for dentists to reach a more realistic consensus regarding alternatives to professional consultation in response to some symptoms and problems.     

Maternal-Infant Attachment: a Developmental Perspective

The formation of a close and satisfying maternal-infant bond is recognized as being an important contribution to the optimal psychosocial development of the child. However the relationship that develops between mother and infant is increasingly seen as an ongoing developmental process rather than a postpartum event, occurring in the first few days after birth. It is also being increasingly recognized that there are a multitude of factors during this period which affect the development of this relationship (14, 15, 16, 17). The father too plays an important role at this time, and his reactions to the birth as well as the support he is able to offer his wife are determinants in the evolving maternal-infant relationship. The view of bonding as an ongoing developmental process influenced by both ante- and postnatal factors, indicates some flexibility of response on the part of the mother when things do not go according to plan. For example, separation of mother and infant in the case of a premature delivery need not have an adverse effect on the development of the maternal-infant relationship provided that there is adequate support for the parents. Well trained I.C.U. staff and hospital practices that are sensitive to the needs of the parents at this time are important determinants here. It is felt that the success of the video programme, and the results of the long-term follow-up programme conducted at the Queen Victoria Hospital support this developmental view.     

Harnessing expertise: involving peer interviewers in qualitative research with hard-to-reach populations

The use of peer interviewers with privileged access to a particular population group, which is difficult to reach via more conventional methods, has been acknowledged in recent research. This paper explores a number of key issues relating to the employment of peer interviewers by reflecting on a project designed to explore the views and experiences of parents who use illegal drugs. The project presented the research team with a number of challenges. These included the need to provide on-going support for the interviewers, a sense of distance felt by the researchers from the raw data they collected, and the difficulties of gaining from the skills and experiences of peer interviewers without exploiting their labour. The paper also explores the advantages of involving peer interviewers closely in research work and reflects on the nature and boundaries of expert knowledge that can become evident in such collaborations. The need for a certain amount of flexibility over the roles and domains of control that lay experts and researchers traditionally inhabit is suggested. In conclusion, it is argued that the involvement of peer interviewers in research can be a valuable means of enhancing our knowledge and understanding of a variety of population groups who tend to live beyond the gaze of more orthodox researchers.     

Extracorporeal shockwave therapy: A systematic review of its use in fracture management

Extracorporeal shockwave therapy is increasingly used as an adjuvant therapy in the management of nonunions, delayed unions and more recently fresh fractures. This is in an effort to increase union rates or obtain unions when fractures have proven recalcitrant to healing. In this report we have systematically reviewed the English language literature to attempt to determine the potential clinical efficacy of extracorporeal shockwave therapy in fracture management. Of 32 potentially eligible studies identified, 10 were included that assessed the extracorporeal shockwave therapy use for healing nonunions or delayed unions, and one trial was included that assessed its use for acute high-energy fractures. From the included, studies'' overall union rates were in favor of extracorporeal shockwave therapy (72% union rate overall for nonunions or delayed unions, and a 46% relative risk reduction in nonunions when it is used for acute high-energy fractures). However, the methodologic quality of included studies was weak and any clinical inferences made from these data should be interpreted with caution. Further research in this area in the form of a large-scale randomized trial is necessary to better answer the question of the effectiveness of extracorporeal shockwave therapy on union rates for both nonunions and acute fractures.     

A description of clients nursed by community psychiatric nurses whilst attending English National Board Clinical Course No. 811: clarification of current role?

The English National Board Clinical Course No. 811 is a 36-week preparation for community psychiatric nurses (CPNs). Unlike health visiting or district nursing the course is not yet a mandatory prerequisite for practice and it has been estimated that, nationally, 23% of all CPNs have been awarded the certificate to date. There are currently 24 course centres in England, offering 420 places annually. The completion of a care study by the course student is a curriculum requirement. The present study aimed to establish the characteristics of clients chosen by course students for such work whilst attending the course in an attempt to obtain a 'proxy' measure of the current CPN role nationally. A stratified random sample of eight course centres was selected--four based in schools of nursing, and a further four located in establishments of higher education. Then within each course centre a stratified random sample of students was selected, who each completed a postal questionnaire. A 79% response was obtained. The results are described and discussed within the context of the CPN's developing role. The findings suggest that many CPNs conceptualize their role and function, to use Caplan's terminology, at the primary prevention level, and see their work as being located firmly in primary health care settings. The desirability of this orientation to CPN intervention is examined, acknowledging both mental health service developments and the wider educational implications.     

The incidence of venous thromboembolism and its effect on survival among patients with primary bladder cancer

BACKGROUND:

The incidence, risk factors, time course, and impact on survival of venous thromboembolism (VTE) in a large, population‐based study of patients with bladder cancer have not been identified previously.

METHODS:

The California Cancer Registry was merged with the California Patient Discharge Data Set to determine the incidence of VTE in patients with newly diagnosed bladder cancer within a 6‐year period. Cox proportional hazards models were used to determine the risk factors for VTE and the effects of VTE on survival.

RESULTS:

Among 24,861 patients with bladder cancer, the 2‐year incidence of VTE was 1.9%. The highest incidence of VTE occurred in the first 6 months regardless of age, sex, race, tumor stage, or histologic subtype. In a multivariate model, significant risk factors for the development of VTE included major surgery, advancing disease stage, and increasing number of comorbidities. Compared with the general population, the 1‐year standardized incidence ratio for VTE in the bladder cancer cohort was 5.3 (95% confidence interval, 4.8‐5.9). Among patients with bladder cancer, significant risk factors for death included advancing disease stage, increasing comorbidities, African‐American race, nontransitional cell carcinoma histology, and the development of VTE.

CONCLUSIONS:

Patients with bladder cancer had a 1.9% 2‐year incidence of VTE. Metastatic disease was the strongest predictor of both VTE and death. It was noteworthy that cancer‐associated surgery was associated with a higher risk of VTE, which differed from the results reported from other studies in solid tumors. VTE was a significant predictor of death in the first 2 years. Cancer 2010. © 2010 American Cancer Society.     

Epithelial membrane protein‐2 expression is an early predictor of endometrial cancer development

BACKGROUND:

Endometrial cancer (EC) is a common malignancy worldwide. It is often preceded by endometrial hyperplasia, whose management and risk of neoplastic progression vary. Previously, the authors have shown that the tetraspan protein epithelial membrane protein‐2 (EMP2) is a prognostic indicator for EC aggressiveness and survival. Here the authors validate the expression of EMP2 in EC, and further examine whether EMP2 expression within preneoplastic lesions is an early prognostic biomarker for EC development.

METHODS:

A tissue microarray (TMA) was constructed with a wide representation of benign and malignant endometrial samples. The TMA contains a metachronous cohort of cases from individuals who either developed or did not develop EC. Intensity and frequency of EMP2 expression were assessed using immunohistochemistry.

RESULTS:

There was a stepwise, statistically significant increase in the average EMP2 expression from benign to hyperplasia to atypia to EC. Furthermore, detailed analysis of EMP2 expression in potentially premalignant cases demonstrated that EMP2 positivity was a strong predictor for EC development.

CONCLUSIONS:

EMP2 is an early predictor of EC development in preneoplastic lesions. In addition, combined with our previous findings, these results validate EMP2 as a novel biomarker for EC development. Cancer 2010. © 2010 American Cancer Society.