Dental fear treatment: comparison of a video training procedure and clinical rehearsals

Abstract – Two types of fear desensitization, video training, and clinical rehearsals, were evaluated using psychometric tests, behavioral measures, and interviews for a group of 68 dental fear patients with high and low general trait anxiety. After treatment, a visual analogue scale (VAS) also tested the degree of perceived anxiety before going off to an unknown dentist. Results indicated no significant differences in dental fear reduction effects of the two types of desensitization. However, both treatments showed significant and meaningful effects when compared with a group of 75 dental fear patients on a waiting list who were also tested once at the beginning of the waiting period and again after 6 months. Only high general anxiety subjects resisted desensitization and failed standardized dental treatment tests. Exit interviews revealed that both groups named securing/accepting personnel, conversations about their fears and relaxation, in that order, as the most important factors in their dental fear reduction. Psychometric trust scores confirmed this. VAS scores showed a significant increase in fear level about the next dentist, also indicating trust as a major factor in reducing dental fear. Suggestions are made about which patient conditions can affect the choice of either of these training methods.     

Efficacy of lumiracoxib in relieving pain associated with knee osteoarthritis: a 6‐week,randomized, double‐blind,parallel‐group study

Aim: The aim of the current study was to assess the efficacy, safety, and tolerability of lumiracoxib 200 mg once daily (o.d.) in relieving osteoarthritis (OA) knee pain in patients in China, Taiwan, and South Korea. Methods: Patients of either sex (aged ≥ 18 years) with symptomatic, primary OA of the knee for ≥ 3 months were eligible for inclusion if they had OA pain intensity of ≥ 40 mm (100 mm visual analogue scale [VAS]) in the target knee joint during the previous 24 h. Patients were required to undergo regular non‐steroidal anti‐inflammatory drug therapy for ≥ 6 weeks. After 3–7 days of screening, patients were randomized (1 : 1) to receive either lumiracoxib 200 mg o.d. or celecoxib 200 mg o.d. The primary efficacy comparison between the study groups was overall OA pain intensity (VAS) in the target knee after 6 weeks of treatment. Results: The mean overall OA pain intensity (VAS) in the target knee after 6 weeks decreased from 60.6 mm to 35.7 mm and 60.5 mm to 36.1 mm in the lumiracoxib and celecoxib groups, respectively. Both study groups showed similar results in terms of improvement in both patient's and physician's global assessment of disease activity and functional health status. The percentage of adverse events (AEs) in the lumiracoxib and celecoxib groups (40.3% and 37.9%, respectively) was similar, as was the proportion of treatment‐related AEs (21.0% and 18.2%, respectively). Conclusions: Lumiracoxib 200 mg o.d. provided effective and well‐tolerated pain relief similar to that achieved with celecoxib 200 mg o.d. in knee OA patients.     

Resolution of skin fibrosis and joint contractures in aggressive diffuse systemic sclerosis using autologous stem cell transplantation

The use of haematopoietic stem cell transplantation (HSCT) has now expanded beyond the domain of haematological diseases. Increasingly, the benefits of intense immunosuppression in the management of severe autoimmune diseases are being recognized. In diffuse systemic sclerosis (SSc), there has been increasing evidence of the efficacy of HSCT in improving morbidity and mortality. We present the first Australian patient to undergo autologous HSCT for SSc and review the current literature in the use of HSCT in SSc. Remarkably, the patient had complete resolution of skin disease (modified Rodnan skin score 27/51–0/51), tenosynovitis, synovitis and myositis.     

GASTRIC EMPTYING DURING LUMBAR EXTRADURAL ANALGESIA IN LABOUR: EFFECT OF FENTANYL SUPPLEMENTATION

We measured gastric emptying (by paracetamol absorption) andduration of analgesia in 30 women in labour after extraduralinjection of 0.375% bupivacaine 10 ml either alone or combinedwith fentanyl 100 fig. Treatment was administered double blindby random allocation after the first request for analgesia.The median (range) times to maximal serum concentration of paracetamolwere 60 (15–90) min and 75 (30–180) min after administrationin the control and fentanyl groups, respectively (P = 0.026),and corresponding mean (95 % confidence interval) maximal concentrationsof paracetamol were 27.3 (18.8–35.8) µg ml^–1and 18.0 (15.1-20.9)µg ml^–1 (P = 0.020). Mean durationof analgesia, from the first extradural bolus until return ofpain in those given bupivacaine alone was 113 (87–139)min and 154 (131–176) min when fentanyl was added to thelocal anaesthetic (P = 0.016). These results confirm the prolongationof analgesia after fentanyl supplementation of lumbar extraduralanalgesia, but indicate that it results in delayed gastric emptying     

LHRH Analogue Treatment for the Prevention of Premenstrual Attacks of Acute Porphyria

We have assessed the value of suppressing ovulation with theluteinizing hormone releasing hormone (LHRH) analogue buserelinin seven patients experiencing crises of acute intermittentporphyria related to the menstrual cycle. Clinical course, plasmaoestradiol and progesterone levels, and urinary porphyrin andprecursor excretion were monitored over a baseline period ofapproximately one year, and then for a similar period on buserelintreatment. There was a trend towards clinical improvement onbuserelin therapy. The median number of attacks fell from sevenduring the baseline period to three on treatment (p=0.06). Theresponse to buserelin varied considerably, with those patientsin whom the association between baseline attacks and the menstrualcycle was strongest gaining the most benefit. All patients becameamenorrhoeie with suppression of plasma oestradiol and progesteronelevels. Urinary aminolaevulinic acid and total porphyrin excretionfluctuated widely both before and during treatment. Our experienceindicates that ovulation suppression may be of value in themanagement of young women in whom recurrent attacks of porphyriaare related to the menstrual cycle.