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Secondary Aim (secondary + aim)
Selected AbstractsPatient reported and anatomical outcomes after surgery for pelvic organ prolapse,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2009Ahmed S. El-Azab Abstract Aim Primary aim was to modify Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) to assess pelvic organ prolapse (POP) in Arabic Muslim women. Secondary aim was to compare functional and anatomical outcomes of POP repair. Methods Questionnaire. A characteristic (prayer) was added to PFIQ. Linguistic validation of questionnaires was then done. Twenty cases were enrolled in a pilot study to test internal consistency and reliability. Subsequent study. Prospective study included women with symptomatic POP,,,stage II. History, examination by POP-Q, and administration of PFDI and PFIQ, were done before and 6 months after surgery. Results Questionnaire. Internal consistency of added question was good (Cronbach ,,=,0.78). Test,retest reliability of individual PFIQ items was variable. Subsequent Study. Between September 2004 and February 2007, 78 consecutive women were included. Cystocele, rectocele, and no site predominated in 74.4%, 17.9% and 7.7% of cases, respectively. Preoperatively 19.2%, 15.4% and 47.4% reported stress, urge, and mixed incontinence, respectively. Overall and individual urinary symptoms scores improved significantly after surgery. There were significant improvements in individual symptoms of constipation, splint to defecate and losing not well formed stools. Low self-esteem was most negative impact of prolapse on quality of life (QoL) followed by prayer. After surgery 90% of subjects had anatomical cure. After surgery, QoL issues are significantly related to anatomic location of prolapse as determined by POP-Q. Conclusions Modified PFIQ and PFDI are suitable to assess POP among Muslim women. Postoperatively, many prolapse-related symptoms and QoL significantly improve after surgery on the short term with an anatomic cure rate of 90%. Neurourol. Urodynam. 28:219,224, 2009. © 2008 Wiley-Liss, Inc. [source] Energy efficiency in gait, activity, participation, and health status in children with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 3 2008Claire Kerr BSc (Hons) Physio PhD The aim of the study was to establish if a relationship exists between the energy efficiency of gait, and measures of activity limitation, participation restriction, and health status in a representative sample of children with cerebral palsy (CP). Secondary aims were to investigate potential differences between clinical subtypes and gross motor classification, and to explore other relationships between the measures under investigation. A longitudinal study of a representative sample of 184 children with ambulant CP was conducted (112 males, 72 females; 94 had unilateral spastic C P, 84 had bilateral spastic C P, and six had non-spastic forms; age range 4-17y; Gross Motor Function Classification System Level I, n=57; Level II, n=91; Level III, n=22; and Level IV, n=14); energy efficiency (oxygen cost) during gait, activity limitation, participation restriction, and health status were recorded. Energy efficiency during gait was shown to correlate significantly with activity limitations; no relationship between energy efficiency during gait was found with either participation restriction or health status. With the exception of psychosocial health, all other measures showed significant differences by clinical subtype and gross motor classification. The energy efficiency of walking is not reflective of participation restriction or health status. Thus, therapies leading to improved energy efficiency may not necessarily lead to improved participation or general health. [source] Randomized trial of botulinum toxin injections into the salivary glands to reduce drooling in children with neurological disordersDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2008S M Reid MClinEpi BAppSc (physio) The primary aim of this randomized, controlled trial was to assess the effectiveness of botulinum toxin A (BoNT-A) injections into the submandibular and parotid glands on drooling in children with cerebral palsy (CP) and other neurological disorders. Secondary aims were to ascertain the duration of any such effect and the timing of maximal response. Of the 48 participants (27 males, 21 females; mean age 11y 4mo [SD 3y 3mo], range 6-18y), 31 had a diagnosis of CP and 15 had a primary intellectual disability; 27 children were non-ambulant. Twenty-four children randomized to the treatment group received 25 units of BoNT-A into each parotid and submandibular gland. Those randomized to the control group received no treatment. The degree and impact of drooling was assessed by carers using the Drooling Impact Scale questionnaire at baseline and at monthly intervals up to 6 months postinjection/baseline, and again at 1 year. Maximal response was at 1 month at which time there was a highly significant difference in the mean scores between the groups. This difference remained statistically significant at 6 months. Four children failed to respond to the injections, four had mediocre results, and 16 had good results. While the use of BoNT-A can help to manage drooling in many children with neurological disorders, further research is needed to fully understand the range of responses. [source] Escherichia coli: a growing problem in early onset neonatal sepsisAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2004Bronwyn JONES Abstract Aims: To review the demographic characteristics, antecedents and outcome for early neonatal Escherichia coli sepsis. Secondary aims were to identify antenatal antibiotic use and to review the antimicrobial susceptibility. Methods: A retrospective chart review was performed for all infants with a positive culture for E. coli from either blood or CSF samples obtained between January 1998 and October 2002. Results: Nineteen liveborn infants with early onset sepsis and one stillborn baby with a positive maternal blood culture for E. coli were identified. Pregnancy complications included multiple pregnancy in five (25%), preterm rupture of membranes 10 (50%) and maternal urinary tract infection in five (25%). Eighteen of the cases were born preterm and two at term. The mortality was 8/20 (40%), and for nine cases with developmental outcome data available, 67% were within normal limits and 33% were abnormal. Of the 20 E. coli isolates 11 (55%) were resistant to amoxycillin and 1 (5%) was resistant to gentamicin. Conclusions: Infants with early onset E. coli sepsis had a poor outcome with high mortality and a third of the survivors manifesting neurodevelopmental impairment. Although amoxycillin resistance is common, there is a low prevalence of gentamicin resistance in local isolates. [source] Using Evidence to Improve Reproductive Health Quality along the Thailand-Burma BorderDISASTERS, Issue 3 2004Tara M. Sullivan The Mae Tao Clinic, located on the Thailand-Burma border, has provided health services for illegal migrant workers in Thailand and internally displaced people from Burma since 1989. In 2001, the clinic launched a project with the primary aim of improving reproductive health services and the secondary aim of building clinic capacity in monitoring and evaluation (M&E). This paper first presents the project's methods and key results. The team used observation of antenatal care and family-planning sessions and client exit interviews at baseline and follow-up, approximately 13 months apart, to assess performance on six elements of quality of care. Findings indicated that improving programme readiness contributed to some improvement in the quality of services, though inconsistencies in findings across the methods require further research. The paper then identifies lessons learned from introducing M&E in a resource-constrained setting. One key lesson was that a participatory approach to M&E increased people's feelings of ownership of the project and motivated staff to collect and use data for programme decision-making to improve quality. [source] Reducing sex under the influence of drugs or alcohol for patients in substance abuse treatmentADDICTION, Issue 1 2010Donald A. Calsyn ABSTRACT Aims In a previous report, the effectiveness of the Real Men Are Safe (REMAS) intervention in reducing the number of unprotected sexual occasions among male drug abuse treatment patients was demonstrated. A secondary aim of REMAS was to reduce the frequency with which men engage in sex under the influence (SUI) of drugs or alcohol. Design Men in methadone maintenance (n = 173) or out-patient psychosocial treatment (n = 104) completed assessments at baseline, 3 and 6 months post-intervention. Participants The participants were assigned randomly to attend either REMAS (five sessions containing information, motivational exercises and skills training, including one session specifically targeting reducing SUI) or human immunodeficiency virus (HIV) education (HIV-Ed; one session containing HIV prevention information). SUI during the most recent sexual event served as the primary outcome in a repeated measures logistic regression model. Findings Men assigned to the REMAS condition reporting SUI at the most recent sexual event decreased from 36.8% at baseline to 25.7% at 3 months compared to a increase from 36.9% to 38.3% in the HIV-Ed condition (tintervention = ,2.16, P = 0.032). No difference between the treatment groups was evident at 6-month follow-up. At each assessment time-point, sex with a casual partner versus a regular partner, and being in methadone maintenance versus psychosocial out-patient treatment, were associated with engaging in SUI. Conclusions Overall, a motivational and skills training HIV prevention intervention designed for men was associated with greater reduction in SUI than standard HIV education at the 3-month follow-up. [source] Smoking cessation during alcohol treatment: a randomized trial of combination nicotine patch plus nicotine gumADDICTION, Issue 9 2009Ned L. Cooney ABSTRACT Aims The primary aim was to compare the efficacy of smoking cessation treatment using a combination of active nicotine patch plus active nicotine gum versus therapy consisting of active nicotine patch plus placebo gum in a sample of alcohol-dependent tobacco smokers in an early phase of out-patient alcohol treatment. A secondary aim was to determine whether or not there were any carry-over effects of combination nicotine replacement on drinking outcomes. Design Small-scale randomized double-blind placebo-controlled clinical trial with 1-year smoking and drinking outcome assessment. Setting Two out-patient substance abuse clinics provided a treatment platform of behavioral alcohol and smoking treatment delivered in 3 months of weekly sessions followed by three monthly booster sessions. Participants Participants were 96 men and women with a diagnosis of alcohol abuse or dependence and smoking 15 or more cigarettes per day. Intervention All participants received open-label transdermal nicotine patches and were randomized to receive either 2 mg nicotine gum or placebo gum under double-blind conditions. Findings Analysis of 1-year follow-up data revealed that patients receiving nicotine patch plus active gum had better smoking outcomes than those receiving patch plus placebo gum on measures of time to smoking relapse and prolonged abstinence at 12 months. Alcohol outcomes were not significantly different across medication conditions. Conclusions Results of this study were consistent with results of larger trials of smokers without alcohol problems, showing that combination therapy (nicotine patch plus gum) is more effective than monotherapy (nicotine patch) for smoking cessation. [source] Standardized health check data from community-dwelling elderly people: the potential for comparing populations and estimating needHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2000Peter Bath PhD Abstract The main aim of this study was to compare EASY-Care data obtained during nurse-administered annual health checks in two populations of older people. A secondary aim was to determine whether a standardized assessment system administered as part of routine practice by a trained nurse during the over-75 health check could generate useful information for comparing population health and functional status of community-dwelling-older people. One hundred and seventy-nine elderly people (aged 75 years and over) from the Woodstock ward, Belfast, having relatively high deprivation; and 238 elderly people from south Hampshire, ranging from affluent wards in New Forest to inner city wards, were assessed using the EASY-Care assessment system as part of their annual health check. There was a high response rate to the standardized assessment in both populations (75% and 79%). Compared to people in south Hampshire, the people in Belfast had higher relative risk of having fair/poor self-rated health, and lower relative risk of having good/sufficient accommodation and of having difficulty chewing. People in Belfast had a higher relative risk of being dependent for six of the seven IADL items and for continence of urine, bathing, grooming, use of the stairs and dressing among the ADL items. The results demonstrate the ability of data generated by assessment system to discriminate between populations of older people when used as part of routine practice. Differences in health and functional status may be associated with deprivation. Data collected during the annual health check about the health and functional status of older people could provide a useful adjunct to census and survey data to measure population needs and to support locality planning. [source] Investigation of the interactions between neutrophils and endodontic isolates of Enterococcus faecalisINTERNATIONAL ENDODONTIC JOURNAL, Issue 4 2010R. Sairafi Aim, The primary aim of this study was to investigate the effect of phagocytosis by neutrophils on the antimicrobial sensitivity of Enterococcus faecalis strains. A secondary aim was to determine whether carriage of a plasmid encoding aggregation substance (AS), which has been reported to increase the survival of some strains inside neutrophils, affected the antimicrobial susceptibility of E. faecalis after phagocytosis by neutrophils. Methodology, An assay was carried out to identify isolates of E. faecalis which demonstrated pheromone-responsive clumping caused by the production of aggregation substance (AS). Four E. faecalis strains grown to both logarithmic and stationary phases were exposed to sodium hypochlorite (NaOCl) and chlorhexidine gluconate (CHX) to determine the minimum inhibitory concentrations of these two agents. The antimicrobial susceptibility tests were repeated with E. faecalis strains which survived phagocytosis by neutrophils for 18 h. Results, As expected a laboratory strain of E. faecalis OG1RF which was AS negative became AS positive after introduction of the pheromone responsive plasmid pCF10 into the bacterium to give strain OG1RF(pCF10). These two strains and two endodontic isolates, E08-584 which demonstrated pheromone-responsive clumping and E08-398 which did not, were selected for further study All the test E. faecalis strains were inhibited by low concentrations of sodium hypochlorite (MIC range 0.02,0.3%) and chlorhexidine gluconate (MIC range 0.0004,0.004%). Bacteria recovered from inside neutrophils after 18 h following phagocytosis were susceptible to both ¼MIC and MIC of CHX and NaOCl. Conclusions, Aggregation substance did not appear to affect the antimicrobial susceptibility of any of the strains to CHX or NaOCl. All of the E. faecalis strains examined were capable of survival for 18 h inside the neutrophils following phagocytosis; regardless of their capacity to produce aggregation substance. In addition, all strains of E. faecalis had enhanced susceptibilities to the antimicrobial agents after residence inside neutrophils for 18 h. [source] A comparison between clearing and radiographic techniques in the study of the root-canal anatomy of maxillary first and second molarsINTERNATIONAL ENDODONTIC JOURNAL, Issue 5 2004O. E. Omer Abstract Aim, To compare a clearing technique with conventional radiography in studying certain features of the root-canal system of maxillary right first and second molars. A secondary aim was to assess interexaminer agreement for these features using radiographs. Methodology, Eighty-three recently extracted permanent maxillary right first molars and 40 recently extracted maxillary right second molars from an Irish population were included. Standard periapical radiographs were taken from a buccolingual and mesiodistal direction. The specimens were then decoronated, demineralized in 10% hydrochloric acid for 8 days and then cleared using methyl salicylate. The cleared teeth were examined using a dissecting microscope (×20), and data relating to number of roots, canal type following Vertucci's classification, presence of lateral canals, presence of transverse anastomoses and position/number of apical foramina were collected. The radiographs were examined by two independent trained endodontists using an X-ray viewer and a magnifying lens (×2) in a dark room for the same features studied using the clearing technique. Results, The Kappa values for the agreement between the radiographic examiners A and B and the clearing technique and between the two examiners for the number of roots were 0.60, 0.64 and 0.53; for the root-canal type, 0.37, 0.41 and 0.42; for the number of roots with lateral canals, 0.21, 0.18 and 0.14; and for the transverse anastomoses, 0.29 for radiographic Examiner A. Radiographic Examiner B did not feel capable of accurately recognizing transverse anastomoses from the radiographs. For the position/number of apical foramina, the Kappa values were 0.33 and 0.24, respectively. In general, the Kappa values were low to modest for all comparisons. Conclusions, It is concluded that the agreement between the two radiographic examiners and the agreement between either radiographic examiner and the clearing technique were poor to moderate, indicating the limited value of radiographs alone when studying certain aspects of the root-canal system. [source] A survey of specialist paediatric dental services in Sweden: results from 2003, and trends since 1983INTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 2 2006G. KLINGBERG Summary. The child population in Sweden has changed dramatically during the last 20 years. Changes have also occurred within the Public Dental Service (PDS), regarding the provision of dental care to children and adolescents. All these changes may affect the referral pattern and provision of specialist dental care for children and adolescents. Objectives., The primary aim of this study was to survey the services provided by specialists in paediatric dentistry in Sweden during 2003. A secondary aim was to compare the results with previous surveys. Methods., A Web-based survey was sent to all 34 specialist paediatric dentistry clinics and was answered by all clinics. Data were compared with results from the surveys performed in 1983, 1989, and 1996. Results., The number of paediatric dentists had been relatively constant over the last 20 years, whereas the number of children referred to paediatric dentists had increased by 28% since 1983. It was estimated that 1·3% of all children in Sweden are treated at a specialist paediatric dental clinic in 2003. Dental treatment need in combination with behaviour management problems (BMP) was the main reason for referral and occurred in 37% of all referrals. The proportion of medically compromised children/children with disabilities had increased from 6% in 1983 to 22% in 2003. The number of patients treated using sedation and general anaesthesia had increased since 1983, and particularly since 1996. Conclusions., Despite improvements in dental health among children and adolescents in Sweden during the last 20 years, an increasing number of children are referred for specialist paediatric dental treatment. There is an urgent need to increase the number of specialist paediatric dentists in Sweden in order to ensure the continuation of high quality of dental care for children and adolescents. [source] Relationship between two anxiety instruments in patients receiving mechanical ventilatory supportJOURNAL OF ADVANCED NURSING, Issue 5 2004Linda L. Chlan PhD RN Aims., The primary aim of this paper is to discuss the relationship between the Visual Analog Scale-Anxiety (VAS-A) and the Spielberger State Anxiety Inventory (SAI) in patients receiving mechanical ventilatory support. A secondary aim is to provide suggestions for the nurse-researcher to consider when selecting an instrument to measure anxiety. Background., Anxiety is a common experience for critically ill patients receiving mechanical ventilatory support. It is a challenge, however, for nurse-researcher to select an instrument to measure anxiety that is valid and reliable yet does not cause great response burden for participants. Visual analog scales may reduce response burden, but lack sound validation in research participants receiving mechanical ventilatory support. Methods., This study used a correlational design. A convenience sample of critically ill patients receiving mechanical ventilatory support (n = 200) were asked to rate their current level of anxiety on the 20-item Spielberger SAI and a 100-mm VAS-A. Results., Eight participants were unable to complete the Spielberger SAI; 100% completed the VAS-A. The two instruments were found to be significantly correlated at r = 0·50; P = 0·01. Conclusion., The VAS-A was found to be less burdensome for research participants than the Spielberger SAI, resulting in no missing data on the VAS-A. Findings from this study provide initial validation of the VAS-A as a justifiable instrument to measure anxiety in patients receiving mechanical ventilatory support. Researchers are advised to balance reliability and validity properties with response burden when selecting an instrument to measure anxiety in patients with communication challenges and energy limitations. [source] An examination of the intentional and unintentional aspects of medication non-adherence in patients diagnosed with hypertensionJOURNAL OF CLINICAL NURSING, Issue 4 2007Elaine Lehane MSc Aims., The primary aim of this study was to describe the unintentional and intentional aspects of non-adherence in patients diagnosed with hypertension. A secondary aim was to examine the relationships between medication adherence and purposeful actions (intentional non-adherence), patterned behaviours (unintentional non-adherence) and demographic questionnaire variables. Background., Non-adherence to medications continues to be a significant health-care issue, the extent and consequences of which have been well documented. Despite considerable research over the past five decades, little progress has been made in solving this healthcare problem. Recent literature indicates that this lack of progress can be attributed to the fact that past research has concentrated solely upon either the unintentional or the intentional aspects of non-adherence, instead of addressing both facets simultaneously. Methods., A quantitative, descriptive, correlation research design was employed using Johnson's (2002) Medication Adherence Model as a theoretical framework. A convenience sample of 73 participants with hypertension, attending the outpatients' clinics of two university hospitals was recruited. Data were collected by means of a researcher administered questionnaire and analysed using the Statistical Package for Social Sciences. Results., High levels of medication adherence with a mean adherence score of 4·75 (maximum 5) were reported. Low and medium levels of purposeful actions and medium and high levels of patterned behaviours towards medication taking were found. Correlational analyses did not demonstrate statistically significant associations. Conclusions., Both the intentional and unintentional dimensions of medication-taking are simultaneously considered by patients to varying levels when adhering to therapeutic regimens. This is an important research area for nurses as it facilitates an increased understanding of non-adherence and, in so doing, aids the uncovering of more effective interventions aimed at sustaining lifelong pharmacotherapy. Relevance to clinical practice., By acknowledging a broader approach to patient medication-taking, nurses will be able more effectively to assess and intervene in non-adherent behaviours and actions. [source] Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patientsJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2006P. J. Barry MB Summary Background:, In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) , 2003 version]. The Beers' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers' criteria CD contains 19 different categories containing possible drug,disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug,disease interactions. Objectives:, The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. Methods:, A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80·3 ± 6·1 years) and all patients had both Beers' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. Results:, The results of the study identified a high rate of inappropriate prescribing among this population of community-dwelling subjects. The total number of inappropriate prescriptions identified using the Beers' criteria (ID) was 148 affecting 121 patients. The Beers' criteria (CD) identified 69 inappropriate prescriptions in 60 patients and the IPET identified 112 inappropriate prescriptions in 78 patients. The Beers criteria (ID and CD combined) identified at least one inappropriate prescription in 34% of subjects and the IPET identified one in at least 22% of subjects. Conclusions:, This study identifies high rates of use of inappropriate medications in community-dwelling elderly presenting with acute illness to hospital. These are comparable with inappropriate prescribing rates identified in previous studies. The revised Beers' criteria (2003) identified more inappropriate prescriptions than the IPET in this population of elders. [source] The Association of Alcohol-Induced Blackouts and Grayouts to Blood Alcohol ConcentrationsJOURNAL OF FORENSIC SCIENCES, Issue 4 2006Paul J. Perry Ph.D. ABSTRACT: The primary aim of this study was to investigate the association between measured blood alcohol concentration (BAC) and the presence and degree of amnesia (no amnesia, grayout, or blackout) in actively drinking subjects. A secondary aim was to determine potential factors other than BAC that contribute to the alcohol-induced memory loss. An interview questionnaire was administered to subjects regarding a recent alcohol associated arrest with a documented BAC greater than 0.08 g/dL for either public intoxication, driving under the influence, or under age drinking was administered. Demographic variables collected included drinking history, family history of alcoholism, presence of previous alcohol-related memory loss during a drinking episode, and drinking behavior during the episode. Memory of the drinking episode was evaluated to determine if either an alcohol-induced grayout (partial anterograde amnesia) or blackout (complete anterograde amnesia) occurred. Differences in (1) mean total number of drinks ingested before arrest, (2) gulping of drinks, and (3) BAC at arrest were found for those having blackouts compared with no amnesia; while differences in drinking more than planned were found between the no amnesia and grayout groups. A strong linear relationship between BAC and predicted probability of memory loss, particularly for blackouts was obvious. This finding clinically concludes that subjects with BAC of 310 g/dL or greater have a 0.50 or greater probability of having an alcoholic blackout. [source] Offline adaptive radiotherapy for bladder cancer using cone beam computed tomographyJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 2 2009F Foroudi Summary We investigated if an adaptive radiotherapy approach based on cone beam CT (CBCT) acquired during radical treatment was feasible and resulted in improved dosimetric outcomes for bladder cancer patients compared to conventional planning and treatment protocol. A secondary aim was to compare a conventional plan with a theoretical online process where positioning is based on soft tissue position on a daily basis and treatment plan choice is based on bladder size. A conventional treatment plan was derived from a planning CT scan in the radical radiotherapy of five patients with muscle invasive bladder cancer. In this offline adaptive protocol using CBCT, the patients had 10 CBCT: daily CBCT for the first five fractions and then CBCT scan on a weekly basis. The first five daily CBCT in each patient were used to create a single adaptive plan for treatment from fraction eight onwards. A different process using the planning CT and the first five daily CBCT was used to create small, average and large bladder volumes, giving rise to small, average and large adaptive bladder treatment plans, respectively. In a retrospective analysis using the CBCT scans, we compared the clinical target volume (CTV) coverage using three protocols: (i) conventional; (ii) offline adaptive; and (iii) online adaptive with choice of ,plan of the day'. Daily CBCT prolonged treatment time by an average of 7 min. Two of the five patients demonstrated such variation in CTV that an offline adaptive plan was used for treatment after the first five CBCT. Comparing the offline adaptive plan with the conventional plan, the CTV coverage improved from a minimum of 60.1 to 94.7% in subsequent weekly CBCT. Using the CBCT data, modelling an online adaptive protocol showed that coverage of the CTV by the 95% prescribed dose line by small, medium and large adaptive plans were 34.9, 67.4 and 90.7% of occasions, respectively. More normal tissue was irradiated using a conventional CTV to planning target volume margin (1.5 cm) compared to an online adaptive process (0.5 cm). An offline adaptive strategy improves dose coverage in certain patients to the CTV and results in a higher conformity index compared to conventional planning. Further research in online adaptive radiation therapy for bladder cancer is indicated. [source] Development of a clinical chart audit programmeJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2006Y Zissiadis Summary Radiation oncology charts containing medical information and treatment details are the major methods of communication between the various personnel involved in delivering radiation therapy to the patient. It is paramount to good patient care for this communication to be clear, precise and accurate in detail. A regular chart audit should be a part of the quality assurance programme of every radiation oncology department. The primary aim of this study was to develop and assess an objective and quantitative programme for reviewing radiation oncology charts, thereby improving the quality of communication and hence patient management. A secondary aim was to compare the charts of radically treated patients with those treated palliatively. A pilot study using a new chart review tool, developed at the Perth Radiation Oncology Centre, was carried out over an 8-month period. A sample of charts, representing 25% of our treatment group, were assessed using the tool on a monthly basis. A total of 156 charts were reviewed during this time period. Fifty-six per cent were radical treatments and 44% were palliative. The overall mean chart scores significantly improved over the time of this study (P < 0.001). The individual radiation oncologists' scores were also seen to improve during the study period. The alpha coefficients for intra-rater and inter-rater reliability were 0.99 and 0.88, respectively. The chart review programme was found to be an easy-to-use and a reliable tool by both medical and non-medical reviewers. It appeared to have a positive influence on the standard of radiation oncology charts in our department. [source] Quality of life in patients with burning mouth syndromeJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 7 2008Pía López-Jornet Objective:, To study the quality of life in patients with burning mouth syndrome (BMS), our primary aim was to compare BMS patients with healthy controls and the secondary aim was to compare subgroups of BMS patients on the type of therapy received; using the Medical Outcome Short Form Health Survey Questionnaire (SF-36) and the Oral Health Impact Profile (OHIP-49) as measurement instruments. Method:, Sixty consecutive patients (10 males and 50 females) with BMS were studied in the Department of Oral Medicine (Faculty of Medicine and Dentistry, University of Murcia, Spain), while 60 healthy patients were used as controls. The Spanish version of the SF-36 was used to evaluate general quality of life, together with the OHIP-49 in its Spanish version. Results:, Regarding general quality of life as assessed with the SF-36, and on comparing the BMS vs. the control groups, lower scores were obtained in the former in all domains (P < 0.001). The OHIP-49 in turn yielded significant differences in each of the domains vs. the controls. No significant differences were found between the patients with BMS in any domain regarding parafunctional habits and the presence of dentures. In relation to the different treatments, significant differences were recorded in functional limitation (P = 0.02) and physical pain (P = 0.033). Conclusion:, Patients with BMS yield poorer scores on all scales vs. the healthy controls when applying the SF-36 and OHIP-49. [source] An in vivo Study of the Relationship between Craving and Reaction Time during Alcohol Detoxification Using the Ecological Momentary AssessmentALCOHOLISM, Issue 12 2005M Lukasiewicz Abstract: Background: To study cognitive interference associated with craving for alcohol, the Ecological Momentary Assessment (EMA) method was used to measure the relationship between craving and reaction time. A secondary aim was the study of the predictive factors for craving during alcohol detoxification. The EMA enables both repeated measures of craving in a natural setting and the recording of reaction time without the patient being aware of this. Methods: Craving for alcohol, reaction time, sadness and anxiety were recorded 8 to 12 times a day, over three weeks of detoxification in 14 alcoholics (n= 1767 measures), on an electronic diary issuing random prompts. Mixed models were used for statistical analysis (,= 5%, 1-,= 88%). Results: Reaction time was significantly increased in univariate analysis when a craving episode occurred but this difference did not persist after multivariate analysis. Craving episodes were more frequent and intense than previously reported. Predictive factors of craving during detoxification were: age, gender, sadness, anxiety and the number of previous detoxifications. Antidepressants, anticraving medications but not benzodiazepines were negatively associated to craving. [source] Increased interleukin-18 in gingival crevicular fluid from periodontitis patientsMOLECULAR ORAL MICROBIOLOGY, Issue 2 2008C. M. Figueredo Introduction:, This study aimed to measure the levels of interleukin-18 (IL-18) in inflamed shallow sites and inflamed deep sites in patients with periodontitis and to compare the data with results from inflamed shallow sites in patients with gingivitis. A secondary aim was to examine the composition of the subgingival microbiota in the sampled sites. Methods:, Gingival crevicular fluid was collected from five gingivitis sites and five periodontitis sites from 18 patients with chronic periodontitis, and from five gingivitis sites from 15 patients with gingivitis. Samples from each site category were pooled and IL-18 levels were measured using an enzyme-linked immunosorbent assay. The subgingival microbiota was analyzed by checkerboard DNA,DNA hybridization. Results:, All clinical parameters and gingival crevicular fluid volumes were higher in periodontitis sites compared with gingivitis sites from patients with periodontitis and gingivitis. The total amount of IL-18 was higher in periodontitis sites than gingivitis sites in both periodontitis (P = 0.018) and gingivitis (P = 0.002) patients and was higher in gingivitis sites from periodontitis patients than in those from gingivitis patients (P = 0.015). There were higher levels of Tannerella forsythia, Porphyromonas gingivalis, and Treponema denticola (red complex species) in periodontitis sites compared with gingivitis sites in both the periodontitis and gingivitis patients (P < 0.001). Conclusion:, Levels of IL-18 were higher in patients with chronic periodontitis compared with patients with gingivitis, even at sites with similar pocket depths. The presence of similar levels of red complex species in gingivitis sites from periodontitis patients and from gingivitis patients suggested that the higher levels of IL-18 were not associated with a different microbial challenge. [source] The Role of Central Hypersensitivity in the Determination of Intradiscal Mechanical Hyperalgesia in Discogenic PainPAIN MEDICINE, Issue 5 2010Juerg Schliessbach PhD Abstract Objective., The primary aim of the present study was to investigate whether there is a relationship between central hypersensitivity (assessed by pressure pain thresholds of uninjured tissues) and intradiscal pain threshold during discography. The secondary aim was to test the hypothesis that peripheral noxious stimulation dynamically modulates central hypersensitivity. Patients., Twenty-four patients with positive provocation discography were tested for central hypersensitivity by pressure algometry before and after the intervention with assessments of pressure pain detection and tolerance thresholds. Intradiscal pain threshold was assessed by measuring intradiscal pressure at the moment of pain provocation during discography. Correlation analyses between intradiscal pain threshold and pressure algometry were made. For the secondary aim, pressure algometry data before and after discography were compared. Results., Significant correlation with intradiscal pain threshold was found for pressure pain detection threshold at the toe (regression coefficient: 0.03, P = 0.05) and pressure pain tolerance thresholds at the nonpainful point at the back (0.02, P = 0.024). Tolerance threshold at the toe was a significant predictor for intradiscal pain threshold only in multiple linear regression (0.036, P = 0.027). Detection as well as tolerance thresholds significantly decreased after discography at the painful and the nonpainful point at the back, but not at the toe. Conclusions., Central hypersensitivity may influence intradiscal pain threshold, but with a modest quantitative impact. The diagnostic value of provocation discography is therefore not substantially impaired. Regional, but not generalized central hypersensitivity is dynamically modulated by ongoing peripheral nociceptive input. [source] Asthma in late adolescence , farm childhood is protective and the prevalence increase has levelled offPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 5 2010Göran Wennergren Wennergren G, Ekerljung L, Alm B, Eriksson J, Lötvall J, Lundbäck B. Asthma in late adolescence , farm childhood is protective and the prevalence increase has levelled off. Pediatr Allergy Immunol 2010: 21: 806,813. © 2010 John Wiley & Sons A/S While the prevalence of and risk factors for asthma in childhood have been studied extensively, the data for late adolescence are more sparse. The aim of this study was to provide up-to-date information on the prevalence of and risk factors for asthma in the transitional period between childhood and adulthood. A secondary aim was to analyze whether the increase in asthma prevalence has levelled off. A large-scale, detailed postal questionnaire focusing on asthma and respiratory symptoms, as well as possible risk factors, was mailed to 30 000 randomly selected subjects aged 16,75 in Gothenburg and the surrounding western Sweden region. The present analyses are based on the responses from 1261 subjects aged 16,20 (560 men and 701 women). The prevalence of physician-diagnosed asthma was 9.5%, while 9.6% reported the use of asthma medicine. In the multivariate analysis, the strongest risk factors for physician-diagnosed asthma and other asthma variables were heredity for asthma and heredity for allergy, particularly if they occurred together. Growing up on a farm significantly reduced the prevalence of physician-diagnosed asthma and the likelihood of using asthma medication, OR 0.1 (95% CI 0.02,0.95). Smoking increased the risk of recurrent wheeze, long-standing cough, and sputum production. In conclusion, the prevalence of physician-diagnosed asthma and the use of asthma medication in the 16- to 20-yr age group support the notion that the increase in asthma prevalence seen between the 1950s and the 1990s has now levelled off. In line with the hygiene hypothesis, a farm childhood significantly reduced the likelihood of asthma. The adverse effects of smoking could already be seen at this young age. [source] Study design of the Trial to Reduce IDDM in the Genetically at Risk (TRIGR)PEDIATRIC DIABETES, Issue 3 2007The TRIGR Study Group Abstract:, The hypothesis for this study is that weaning to an extensively hydrolyzed infant formula will decrease the incidence of type 1 diabetes (T1D), as it does in all relevant animal models for the disease. This will be tested in children who carry risk-associated human leukocyte antigen genotypes and have a first-degree relative with T1D. The trial will use a double-blind, prospective, placebo-controlled intervention protocol, comparing casein hydrolysate with a conventional cow's milk (CM)-based formula. A secondary aim is to determine relationships between CM antibodies, a measure of CM exposure, and diabetes-associated autoantibodies. To achieve an 80% power for the detection of a 40% intervention-induced difference in the development of autoantibodies and subsequent diabetes, the study requires 2032 subjects. A multicenter, international, collaborative effort is necessary to achieve recruitment targets. A collaborative international study group of 78 clinical centers in 15 countries has therefore been assembled for this purpose. [source] ORIGINAL RESEARCH,BASIC SCIENCE: A Prospective Study Examining the Anatomic Distribution of Nerve Density in the Human VaginaTHE JOURNAL OF SEXUAL MEDICINE, Issue 6 2006Rachel Pauls MD ABSTRACT Introduction., Women possess sufficient vaginal innervation such that tactile stimulation of the vagina can lead to orgasm. However, there are few anatomic studies that have characterized the distribution of nerves throughout the human vagina. Aim., The aim of this prospective study was to better characterize the anatomic distribution of nerves in the adult human vagina. A secondary aim was to assess whether vaginal innervation correlates with the subject's demographic information and sexual function. Methods., Full-thickness biopsies of anterior and posterior vagina (proximal and distal), cuff, and cervix were taken during surgery in a standardized manner. Specimens were prepared with hematoxylin and eosin, and S100 protein immunoperoxidase. The total number of nerves in each specimen was quantified. Enrolled patients completed a validated sexual function questionnaire (Female Sexual Function Index, FSFI) preoperatively. Main Outcome Measures., A description of vaginal innervation by location and an assessment of vaginal innervation in association with the subject's demographic information and sexual function. Results., Twenty-one patients completed this study, yielding 110 biopsy specimens. Vaginal innervation was somewhat regular, with no site consistently demonstrating the highest nerve density. Nerves were located throughout the vagina, including apex and cervix. No significant differences were noted in vaginal innervation based on various demographic factors, including age, vaginal maturation index, stage of prolapse, number of vaginal deliveries, or previous hysterectomy. There were no correlations between vaginal nerve quantity and FSFI domain and overall scores. Fifty-seven percent of the subjects had female sexual dysfunction; when compared to those without dysfunction, there were no significant differences in total or site-specific nerves. Conclusions., In a prospective study, vaginal nerves were located regularly throughout the anterior and posterior vagina, proximally and distally, including apex and cervix. There was no vaginal location with increased nerve density. Vaginal innervation was not associated with demographic information or sexual function. Pauls R, Mutema G, Segal J, Silva WA, Kleeman S, Dryfhout V, and Karram M. A prospective study examining the anatomic distribution of nerve density in the human vagina. J Sex Med 2006;3:979,987. [source] SPICeD: imaging the deep EarthASTRONOMY & GEOPHYSICS, Issue 3 2001Michael Kendall FRAS Michael Kendall and George Helffrich respond to Alan Douglas's paper in the previous issue of Astronomy & Geophysics with a prototype three-component broadband seismic network for the UK. There are two boundaries in the Earth's deep interior that are as significant in terms of contrast in material properties and dynamics as the lithosphere,atmosphere boundary, where we live. The natures of the core-mantle boundary and the inner-core/outer-core boundary have significant implications for the stability of the Earth's magnetic field, style of convection, moment of inertia and length of day. An array of broadband three-component seismometers (SPICeD) spanning Scotland, England and France has been deployed with the aim of studying these dramatic interfaces within the Earth. A secondary aim of the deployment was to install a working prototype for a permanent three-component broadband seismic network in the UK, as advocated by Alan Douglas in the previous issue of this journal (Douglas 2001). [source] A pilot survey of the impact of menstrual cycles on adolescent healthAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009Cynthia M. FARQUHAR Background: The experience of menstruation and reproductive health by adolescent girls has been poorly studied in New Zealand. Aims: To develop and pilot a Web-based survey of 16-year-olds' experience of menstruation and reproductive health with the eventual objective of conducting a larger population-based survey. A secondary aim was to report on the experience of menstrual and reproductive health in a group of 16-year-old girls in an urban setting. Methods: A Web-based survey was developed and tested in 2006 with assistance of a multidisciplinary advisory group. The final version of the questionnaire had 146 questions in 11 sections and the topics were menstrual history, general health including use of medications, access to medical care or health information, sexual health, family history and personal information including smoking, height, weight, ethnicity, paid employment of parents, drug and alcohol use and exercise patterns. Results: Seventy-five 16-year-old students completed the survey. Twenty-five per cent considered that their periods were quite a bit or a lot of trouble and 10% avoided certain activities during their menstrual periods, nearly 50% of girls always experienced some pain with every period, and 30% had seen a health professional about their period pains. Thirty-three stated that menstruation was moderately to severely painful and that daily activity was affected. Fifty per cent of girls were sexually active and of these 80% described it as painful. Conclusions: The Web-based survey was a successful approach to collecting information and could be used in a larger study. [source] Blood basophil numbers in chronic ordinary urticaria and healthy controls: diurnal variation, influence of loratadine and prednisolone and relationship to disease activityCLINICAL & EXPERIMENTAL ALLERGY, Issue 3 2003C. E. H. Grattan Summary Background The basopenia of chronic urticaria relates to histamine releasing autoantibodies in the serum of patients with autoimmune urticaria. This reduction in circulating basophils may be due to active recruitment into weals. If so, it might be expected that numbers in blood would be reduced when urticaria is active and increased after treatment. The primary aim of this study was to look at diurnal variation of basophil numbers in patients with chronic ordinary urticaria (not physical or vasculitic) in relation to disease activity and the effect of treatment with antihistamines and corticosteroids, and to compare the results with healthy controls. A secondary aim was to compare a standard manual counting method with automated basophil counts and to look at numbers of other circulating leucocytes that might be relevant to urticaria pathogenesis. Methods Manual basophil counts using a toluidine blue stain and automated 5-part differentials (Coulter® Gen. SÔ) were performed at 4-hourly intervals from 08.00 to 20.00 in 10 healthy controls (six women, age 24 to 63 years) and seven chronic urticaria patients (five women, 24 to 50 years). All chronic urticaria patients had severe daily or almost daily urticaria. Only one of six chronic urticaria sera showed in vitro basophil histamine releasing activity. Counts were performed without treatment, after a week of taking loratadine 10 mg daily and after 3 days of adding prednisolone at 0.6 mg/kg/day (maximum 40 mg). Daily urticarial activity scores (UAS) were derived from weal numbers and itch, maximum 7. Results There was no significant overall diurnal variation of basophil numbers in healthy controls or chronic urticaria patients. Mean (SE) manually counted basophil were higher in healthy controls than chronic urticaria (43.4/µL (2.1) vs. 4.4 (0.8), P < 0.001). Basophil counts were reduced in healthy controls on steroids (19.2 (1.9), P < 0.001) but increased in chronic urticaria (8.9 (1.9), P < 0.001). Loratadine did not influence them. UAS fell on treatment (3.3 (0.4) baseline, 1.4 (0.5) on loratadine and 0.5 (0.2) on prednisolone with loratadine, P < 0.001). There was a negative linear correlation between basophil numbers and UAS in untreated chronic urticaria patients (P = 0.001, Spearman rank correlation). Manual and automated basophil counts showed poor agreement. Lymphocyte numbers were lower in chronic urticaria than healthy controls. Neutrophils increased whereas lymphocytes and eosinophils decreased in all subjects on prednisolone. They were unaffected by loratadine. Conclusion The results are consistent with the hypothesis that circulating basophils may be recruited from blood into urticarial weals during disease activity. Automated counts are not suitable for assessing basophil numbers in chronic urticaria. The relevance of reduced lymphocyte numbers in chronic urticaria needs to be explored. [source] Clinical and Radiographic Evaluation of the 5-mm Diameter Regular-Platform Brånemark Fixture:2- to 5-Year Follow-upCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 1 2002DSc Odont, Georges Tawil DDS ABSTRACT Purpose: The purpose of this study was to report the clinical results obtained with 5-mm diameter regular-platform Brånemark implants after 2 to 5 years of follow-up. A secondary aim was to compare the clinical outcome to that of adjacently placed standard 3.75-mm fixtures in the same patients under the same operative condition and in the same prosthetic construction. Materials and Methods: Sixty patients, with a mean age of 54 years, received a total of 97 5-mm diameter regular-platform fixtures. The majority of the implants were placed at molar sites. In 41 of the patients, 53 5-mm diameter implants were placed adjacent to 62 standard 3.75-mm diameter fixtures in the same prosthetic reconstruction. All implants were submerged for an average period of 4 to 6 months. Abutment connection was done according to standard protocol. The prosthetic treatment consisted of freestanding fixed bridges. Results: The cumulative survival rate of the 5-mm diameter implants loaded for a period of 2 to 5 years was 96.9%. Only three implants failed. They were placed in type 4 bone in the posterior maxilla. Bone loss over the first year was 0.70 mm and over a 3-year period 0.81 mm. Implants placed in type 4 bone showed significantly higher bone loss. No difference in the resorption rate could be found between the maxillary and the mandibular implants or between the various implant lengths. There was no significant difference between the bone loss around the 5-mm diameter fixtures and the adjacent 3.75-mm diameter standard fixtures. Conclusion: The present study demonstrated a high predictability of 5-mm diameter regular-platform implants when placed in the posterior maxilla and mandible. [source] The validity of the Computer Science and Applications activity monitor for use in coronary artery disease patients during level walkingCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 4 2002Ulf Ekelund Summary The principal aim of the present study was to examine the validity of the Computer Science and Applications (CSA) activity monitor during level walking in coronary artery disease (CAD) patients. As a secondary aim, we evaluated the usefulness of two previously published energy expenditure (EE) prediction equations. Thirty-four subjects (29 men and five women), all with diagnosed CAD, volunteered to participate. Oxygen uptake (VO2) was measured by indirect calorimetry during walking on a motorized treadmill at three different speeds (3·2, 4·8 and 6·4 km h,1). Physical activity was measured simultaneously using the CSA activity monitor, secured directly to the skin on the lower back (i.e. lumbar vertebrae 4,5) with an elastic belt. The mean (±SD) activity counts were 1208 ± 429, 3258 ± 753 and 5351 ± 876 counts min,1, at the three speeds, respectively (P<0·001). Activity counts were significantly correlated to speed (r=0·92; P<0·001), VO2 (ml kg,1 min,1; r=0·87; P<0·001) and EE (kcal min,1; r=0·85, P<0·001). A stepwise linear regression analysis showed that activity counts and body weight together explained 75% of the variation in EE. Predicted EE from previously published equations differed significantly when used in this group of CAD patients. In conclusion, the CSA activity monitor is a valid instrument for assessing the intensity of physical activity during treadmill walking in CAD patients. Energy expenditure can be predicted from body weight and activity counts. [source] | |||||||||||||||||||||||||||||||