Involving the patient: a prospective study on use, appreciation and effectiveness of an information system in head and neck cancer care

OBJECTIVE: To determine use, appreciation and effectiveness of an electronic health information support system in head and neck (H&N) cancer care. DESIGN: A prospective evaluation study. The evaluated system has four different functions: (1) communication amongst health care providers and between health care providers and patients, (2) information for health care providers and patients, (3) contact with fellow sufferers and (4) monitoring of discharged patients by means of electronic questionnaires. Evaluation of the system was done both objectively using automatically created log files and stored messages, and subjectively by using paper questionnaires from patients and general practitioners (GPs). SETTING: Department of Otorhinolaryngology and Head and Neck Surgery of a tertiary health care centre in the Netherlands. The system was put at patients' disposal for a period of 6 weeks following discharge from the hospital after surgery for H&N cancer, and was additional to standard care. PARTICIPANTS: Head and neck cancer patients, hospital physicians, members of a hospital-based support team, GPs, district nurses and speech therapists. MAIN OUTCOME MEASURES: Actual use of the system by patients and health care providers. Patients' appreciation for each of the system's four different functions. GPs' appreciation for the system. Capability to detect potential patient problems with the system. RESULTS: The system was used by 36 H&N cancer patients, 10 hospital physicians, 2 members of the support team, 8 GPs, 2 district nurses and 2 speech therapists. The total number of patient-sessions was 982: an average of 27.3 sessions per patient during the 6 weeks study period. In total, 456 monitoring questionnaires were completed. The support team in hospital responded with 231 actions. In 16 cases, an extra appointment was made for a patient with the hospital physician. Out of these cases, immediate action was considered necessary eight times. Patients appreciated the system highly, rating it with an average score of 8.0 on a 10-point scale. All patients used the monitoring function, and rated 'monitoring' with a mean score of 8.0 on a 10-point scale. Least used and appreciated was the 'contact with fellow sufferers' function. Only 8 out of possible 36 GPs used the system, rating it with an average of 5.6 on a 10-point scale. CONCLUSIONS: The electronic health information support system was used intensively and highly appreciated by H&N cancer patients. The system enabled the early detection of occurring health problems that required direct intervention. ICT can play an additional role in the management of patients, also in a relatively elderly and computer illiterate patient population.     

National Athletic Trainers' Association Position Statement: Head-Down Contact and Spearing in Tackle Football

OBJECTIVE: To present recommendations that decrease the risk of cervical spine fractures and dislocations in football players. BACKGROUND: Axial loading of the cervical spine resulting from head-down contact is the primary cause of spinal cord injuries. Keeping the head up and initiating contact with the shoulder or chest decreases the risk of these injuries. The 1976 rule changes resulted in a dramatic decrease in catastrophic cervical spine injuries. However, the helmet-contact rules are rarely enforced and head-down contact still occurs frequently. Our recommendations are directed toward decreasing the incidence of head-down contact. RECOMMENDATIONS: Educate players, coaches, and officials that unintentional and intentional head-down contact can result in catastrophic injuries. Increase the time tacklers, ball carriers, and blockers spend practicing correct contact techniques. Improve the enforcement and understanding of the existing helmet-contact penalties.     

头颈部鳞癌中抑癌基因PTEN的研究进展

The FTEN, having a dual specificity phosphatase activity, is the first tumor suppressor gene that possess phosphatase activity hitherto. Many researches have suggested that FTEN play a major role in the tumorgenesis. In clinical, the head and neck squamous cell carcinoma(HNSCC) is one of the most common ma-lignant tumors. In this review, advances in the research of FTEN and the relationship between the PTEN and HNSCC are discussed.     

空心加压螺钉治疗股骨颈骨折的轴向拔出实验研究

目的通过实验,研究影响空心钉在股骨头内稳定性的重要因素,为临床中空心钉治疗股骨颈骨折选择理想的手术方案提供理论依据。方法31枚股骨头标本,空心螺钉按照治疗股骨颈骨折的方法植入股骨头。记录年龄、测量股骨头直径、测量股骨头骨密度、测量钉尖到关节面软骨的距离;同时固定股骨头和螺钉帽,通过实验机进行空心钉轴向拔出实验,记录最大拔出负荷。用SPSS11.5软件包对实验数据进行多元逐步回归分析。结果股骨头骨密度和钉尖到关节面软骨的距离与最大拔出负荷相关,前者呈正相关(P=0.002),而后者呈负相关(P=0)。钉尖到关节面大于8mm组和小于8mm组的最大拔出负荷之间有显著差异(P=0.004)。结论股骨头骨密度越高,一定范围内螺钉植入越深,越有利于内固定的稳定。     

Forelimb reflexes modulated by tonic neck positions in cats

The modulation of monosynaptic forelimb reflexes by tonic neck positions was investigated in cats with the head fixed.Lateral flexion of the body in a horizontal plane markedly facilitates reflexes of the deep radial nerve (DR) in the ipsilateral forelimb, while the antagonistic ulnar nerve (ULN) reflexes are strongly inhibited. Opposite effects are seen after contralateral body movement.Dorsiflexion of the body clearly increases DR-reflexes and exerts a reciprocal although more pronounced inhibition on ULN reflexes. Opposite effects appear after ventriflexion.The reflex modulation starts with head-body displacements of approximately 5° and increases with increasing angles. Furthermore reflex modulation does not depend on the intact cerebrum and cerebellum. The comparison of forelimb and hindlimb reflexes shows a decrease of the neck influences along the spinal cord.Supported by Sonderforschungsbereich Hirnforschung und Sinnes-physiology (SFB 70) der Deutschen Forschungsgemeinschaft (DFG).Essential parts of this paper will be submitted by A. F. as a thesis to the Faculty of Medicine, Freiburg/Breisgau, Germany.     

Participation of Ia reciprocal inhibitory neurons in the spinal circuitry of the tonic neck reflex

Summary As part of our studies of the spinal circuitry of the tonic neck reflex, we have recorded extracellularly from Ia reciprocal inhibitory neurons of the decerebrate, labyrinthectomized cat. The activity of a majority of neurons driven by stimulation of the quadriceps nerve was modulated by sinusoidal rotation of the neck; such modulation was much less frequent in the case of neurons driven by stimulation of nerves to more distal muscles. The results suggest that some of the inhibition which is part of the tonic neck reflex is mediated by Ia reciprocal inhibitory neurons, but that other pathways must also play an important role.     

中药“金黄羔”敷治疗小儿颌下部急性外淋巴腺炎

报道采用局部外敷“金黄羔”治疗小儿颌下部急性淋巴腺炎4例,平均7天治愈,不留瘢痕,既经济又方便病人。     

递进式目标康复护理对老年股骨颈骨折人工置换患者的临床效果

目的：探究递进式目标康复护理对老年股骨颈骨折人工置换患者术后功能恢复的影响及护理体会。方法：选取河南大学第一附属医院2018年6月至2020年8月期间收治的112例老年股骨颈骨折人工置换患者,按照手术先后顺序分为观察组和对照组,各56例。对照组患者实施常规护理,观察组患者实施递进式目标康复护理干预,比较两组患者自我效能水平、髋关节功能及日常活动能力。结果：干预后观察组患者自我效能、髋关节功能、日常活动能力评分均高于对照组,差异具有统计学意义（P <0.05）。结论：递进式目标康复护理干预的应用对促进老年股骨颈骨折人工置换患者自我效能水平,提高术后髋关节功能恢复情况,改善其日常活动能力等方面均具有较高的可行性。     

Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status

Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the oncological treatment of the basic disease, such as radiotherapy (RT) and chemoradiotherapy (CRT), as a consequence of mucositis with the dry mouth, loss of taste, and dysphagia. The severe dysphagia leads to a definitive total impossibility of eating through the mouth in 20–30% of patients. These patients usually require enteral nutritional support. Feeding tubes are a commonly used nutritional intervention during radiotherapy, most frequently percutaneous gastrostomy tube. Recently, a novel HPV-related type of OPC has been described. Patients with HPV-associated OPC are different from the HPV− ones. Typical HPV− OPC is associated with smoking and alcohol abuse. Patients with HPV+ OPC are younger and healthy (without comorbidities) at diagnosis compared to HPV− ones. Patients with OPC are at high nutritional risk, and therefore, they require nutritional support in order to improve the treatment results and quality of life. Some authors noted the high incidence of critical weight loss (CWL) in patients with HPV-related OPC. Other authors have observed the increased acute toxicities during oncological treatment in HPV+ OPC patients compared to HPV− ones. The aim of this paper is to review and discuss the indications for nutritional support and the kinds of nutrition, including immunonutrition (IN), in HNC, particularly OPC patients, undergoing RT/CRT, considering HPV status.