Useful Adjunct (useful + adjunct)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Useful Adjuncts to Harvest Split-Thickness Skin Grafts

Hunter H. Sams MD
Background. Split-thickness skin grafts are useful for repair of defects that are not amenable to primary closure or secondary intention healing. Because of the thinness of split-thickness skin grafts, damage to the graft and curling are common with standard harvesting techniques. Adjunctive methods for harvesting split-thickness skin grafts have not been well elucidated in the literature. Methods. Lubrication and a tongue depressor facilitate even harvesting of the split-thickness skin graft. A semipermeable membrane is applied to the split-thickness skin graft donor site before harvesting the skin graft. This aids with harvesting and minimizes trauma to the graft. Conclusion. Use of lubrication, a tongue depressor, and a semipermeable membrane are useful adjuncts to harvesting split-thickness skin grafts. [source]

Context-Oriented Model Development in Psychotherapy Planning (,COMEPP'): a useful adjunct to diagnosis and therapy of severe personality disorders

M. Fischer-Kern
Objective:, Pathogenous interpersonal (e.g. interfamilial) relationships and reference styles can compromise treatment efforts in severely disturbed (i.e. psychotic or borderline) patients. The integration of family- and individual-centred starting points may be useful in establishing interdisciplinary treatment concepts in these patients. Context-Oriented Model Development in Psychotherapy Planning (COMEPP) represents a diagnostic and therapy planning process, integrating both systemic and psychoanalytic conceptualizations. Method:, COMEPP is exemplified by the case of a young man with psychotic personality disorder who had previously been unresponsive to pharmacological and psychological treatment. Results:, After psycho-dynamical conflicts (i.e. primitive projective processes from the patient's mother to her son) had been elucidated during the COMEPP process, a sufficient treatment setting could be established. Conclusion:, COMEPP provides a psychotherapeutical approach to treatment planning on case-specific premises and may serve as an adjunct to concomitant pharmacological and psychological treatment strategies in so-called ,therapy refractory' patients. [source]

Utility of the thromboplastin-plasma cell-block technique for fine-needle aspiration and serous effusions

D.M.L.T., Manisha B. Kulkarni M.Sc.
Abstract (I) To assess the feasibility of thromboplastin-plasma (TP) method for cell block, (II) to concentrate the minimal cellular material from effusions and needle-rinses by block preparation and improve visual details, (III) to compare conventional cytological smears with cell blocks for final assessment, and (IV) to assess utility of immunocytochemistry (ICC) for diagnostic accuracy. Seventy cell blocks were prepared by TP technique using surplus fluid from 38 serous effusions, and for 32 ultrasonography-guided fine-needle aspiration cytology (FNAC) material, rinses of syringes and needles were collected in normal saline after conventional cytological smears. Then, cell blocks were compared with conventional smears for adequacy, morphologic preservation, and ICC. Absolute concordance seen in 66 cases (94%) between the smears and cell blocks. Advantages with the blocks were cellular concentration in a limited field and better cellular preservation with architectural pattern. Quality of ICC was comparable to that of standard controls. Diagnostic discrepancy was seen in two cases where cell blocks were positive but smears were negative. Two cell blocks were nonrepresentative. Cell block serves as a useful adjunct to traditional cytological smears. TP method is simple, cost effective, and reproducible. It is easy when compared with agar-embedding technique. Ancillary techniques like ICC can be performed successfully. Diagn. Cytopathol. 2009. © 2008 Wiley-Liss, Inc. [source]

Clinical significance of cultures collected from fine-needle aspiration biopsy

Laura A. Granville M.D.
Abstract The rate of positive cultures in fine-needle aspiration biopsy (FNAB) specimens is evaluated, and the value of submitting FNAB culture is assessed. Review of 3,300 FNAB specimens from 2,416 patients were tabulated for culture results, when obtained from the FNAB material. For positive culture results, clinical impact was assessed. Of 3,300 FNAB specimens and 2,416 patients, 185 had cultures performed (6% of specimens, 8% of patients). Of the 185 cultured specimens, 63 (34%) were positive and 122 (66%) were negative. Of the 63 positive cultures, 23 (12% of all FNAB cultures) had a significant impact on patient care. In our institution the FNA culture rate is 6%. When cases with clinical or microscopic suspicion of infection are cultured, 34% are positive for aerobic or anaerobic bacteria, mycobacteria or fungus. Culture in FNA specimens is a useful adjunct to diagnosis and impacts care in 12% of patients cultured at FNAB. This method can be used to triage patients with suspected infectious diseases and can aid in managing patients who may have recurrent infections. Diagn. Cytopathol. 2008;36:85,88. © 2008 Wiley-Liss, Inc. [source]

Diagnosis of melanoma aspirates on ThinPrep®: The University of Michigan experience

Güliz Akdas Barkan M.D.
Abstract The purpose of this study was to compare the cytologic features of melanoma fine-needle aspirates (FNAs) prepared by ThinPrep® (TP) with those in conventional smears (CS) and to identify any diagnostic pitfalls. Fifty-one aspirates diagnosed as melanoma were obtained, 36 of which were prepared by both TP and CS. The preparations were evaluated for cellularity, cell aggregates, cellular appearance, melanin pigment, cytoplasmic, and nuclear features. Categorical data were analyzed by the chi-square test and continuous data by the Wilcoxin-signed rank test. Correlation was determined by Spearman's test for bivariate correlations (rho). Good correlation between the two methods was identified for the following features: cellularity, cell type, bi/multinucleated cells, cytoplasmic features, NC ratio, and presence of macronucleoli. TP exhibits coarser chromatin compared to CS (P = 0.005). Six of 36 CS contained large cellular groups; none of the TP contained them (P = 0.018). Twenty-five of 36 CS contained intranuclear inclusions as opposed to 12/36 TP (P < 0.001). The number of inclusions was significantly reduced on TP. The amount of intracellular melanin was the same with both techniques. Background melanin was markedly reduced on TP except when either trapped by fibrin or attached to cellular clusters (P = 0.006). Background blood was also markedly reduced on TP (P < 0.005). In summary, the cytological features of TP and CS for FNA evaluation of melanoma correlate well; however, one needs to be aware of the cytologic alterations introduced by TP. TP is a sufficient preparation method in the diagnosis of melanoma FNA aspirates when performed by clinicians. It is also a useful adjunct in bloody or low-cellular aspirates, where it tends to reduce the background blood and concentrate the cells. Diagn. Cytopathol. 2002;26:334,339. © 2002 Wiley-Liss, Inc. [source]

Dobutamine Stress Magnetic Resonance Imaging

F.A.C.C., F.A.C.P., F.A.S.E., Pairoj Rerkpattanapipat M.D.
Measurements of left ventricular function with cardiovascular magnetic resonance (CMR) at rest and during intravenous dobutamine are useful for identifying myocardial ischemia, viability, and the risk of subsequent cardiovascular events. Without ionizing radiation, intravascular iodinated contrast administration, or acoustic window limitations, CMR has emerged as a useful adjunct to transthoracic echocardiography for assessing patients with or suspected of having coronary artery disease. [source]

Evaluation of PG-M3 antibody in the diagnosis of acute promyelocytic leukaemia

Sanjeev Kumar Gupta
Eur J Clin Invest 2010; 40 (10): 960,962 Abstract Background & objectives, Acute promyelocytic leukaemia (APL) is a distinct subtype of acute myeloid leukaemia (AML) characterized by a reciprocal translocation, t(15;17) and a high incidence of life-threatening coagulopathy. APL diagnosis is considered a medical emergency. As reverse transcription-polymerase chain reaction (RT-PCR) for PML-RAR, fusion oncoprotein is time consuming, there is a need for a rapid and accurate diagnostic test for APL. This study evaluates the role of PG-M3 monoclonal antibody using immunofluorescence (IF) in the early diagnosis of APL. Materials and Methods, Thirty-six new untreated APL cases diagnosed with RT-PCR for PML-RAR, as the gold standard and 38 non-APL controls (28 non-APL AMLs and 10 non-leukaemic samples) were evaluated by routine morphology and cytochemistry, RT-PCR and IF using PG-M3 monoclonal antibody. Results, Using IF, 34 of 36 (94·4%) APL cases showed a microgranular pattern suggestive of APL and two cases (5·6%) showed a speckled pattern typical of wild-type PML protein (False negative). By comparison, two of 28 (7·1%) non-APL AMLs showed microgranular pattern (false positive). Hence, IF as a diagnostic test for APL resulted in a sensitivity of 94·4%, specificity of 92·9% and positive and negative predictive values of 94·4% and 92·9% respectively. All 10 non-leukaemic samples showed a speckled pattern. Conclusions, IF using PG-M3 antibodies can be used as a rapid (takes 2 h), cheap, sensitive and specific method to identify APL. It can be a useful adjunct for diagnosis of APL especially if facilities for RT-PCR are not available, particularly in resource-limited settings. [source]

Development and evaluation of a cd-rom to support student learning in dentist,patient communication

J. T. Newton
The interaction between dentist and patient is central to the provision of effective healthcare. A multidisciplinary team containing expertise in the social and behavioural sciences, medicine, dentistry, education and information technology was formed to design a CD-ROM to support more traditional teaching and learning in this area. The final version of the program consists of a ,virtual' patient from whom students are asked to take a medical history. The ,patient' interacts with the student and responds to the style of their questioning by changes in anxiety, or degree of annoyance. To date, the CD-ROM has been evaluated in two stages. The first stage was a predictive formative evaluation by the research/development team, and the second stage was a formative evaluation by 144 dental students of the first full prototype. A third stage, to be conducted next year, will involve measuring the longer term impact of the CD-ROM through the assessment of students' abilities to communicate with patients. The evaluation had two components: students made rates of how useful and easy to use they found the program, and students' attitudes towards interacting with patients were evaluated adopting constructs from the theory of Planned Behaviour. Students were positive about the use of the CD-ROM, though they requested some changes in the functionality of the program. Compared to a sample of students who had not used the CD-ROM, the students who used the CD-ROM felt more positive about communicating with their patients, at the end of the course, and expressed stronger intentions to communicate well with patients. We conclude that the CD-ROM we have developed in a useful adjunct to learning in dentist,patient communication. [source]

Personality types of dental school applicants

David O. Morris
A questionnaire-based prospective study was carried out to measure the personality styles of students being interviewed for a place on the 1997/98 dental undergraduate course in Leeds, England. A total of 334 applicants attended for interview between November 1997 and March 1998, of which 311 anonymously and voluntarily completed a personality questionnaire. The Keirsey Temperament Sorter was used to measure the strength and nature of preferences along four dimensions: extroversion-introversion (E-I), sensing-intuition (S-N), thinking-feeling (T-F) and judging-perceiving (J-P). 4 personality types accounted for 79% of the students, 21% were divided among nine personality types with no type comprising more than 6.7% of the students. The remaining 3 possible personality types were not represented in this student population. Further comparisons revealed significant differences between this student sample and the general population in the judging-perceiving preference and also an intra-group gender difference with regard to the thinking-feeling (T-F) preference. A predominance of the S-J (sensing with judging) temperament type was also confirmed. Personality questionnaires may be a useful adjunct in the selection process of dental school applicants. The identification of a student's working and learning style preference has implications for both the dental undergraduate curriculum and the teaching methods employed by dental school staff. [source]

CSF biomarker profile and diagnostic value in vascular dementia

G. P. Paraskevas
Background and purpose:, The differential diagnosis between vascular dementia (VD) and Alzheimer's disease (AD) or mixed dementia (MD) is not always easy in clinical practice. The purpose of the present study was to evaluate the cerebrospinal fluid (CSF) biomarkers tau protein in its total (,T) or hyperphosphorylated at threonin-181(,P-181) form and beta amyloid peptide 1,42 (A,42) alone and their combinations to investigate their diagnostic value in the discrimination between VD and AD or MD. Methods:, The above CSF biomarkers were determined in duplicate and blind to the clinical diagnosis by double sandwich, enzyme-linked immunosorbent assay (ELISA) commercial kits (Innogenetics, Gent, Belgium) in 92 AD patients, 23 VD patients, 17 patients with MD and 68 controls. Results:, Alzheimer's disease and MD showed increased levels of ,T, ,P and reduced levels of A,42 as compared with the controls. The best discrimination between VD and AD or MD was achieved by the combination of all three biomarkers, correctly classifying ,85% of patients, either in the form of a discriminant function or in the form of the ,T × ,P-181/A,42 formula. Conclusions:, Cerebrospinal fluid biomarkers may be a useful adjunct for the discrimination between AD/ MD and VD in every day clinical practice. [source]

EMCyberSchool An Evaluation of Computer-assisted Instruction on the Internet

Kevin M. Baumlin MD
Abstract. Objectives: To test the hypothesis that integration of the EMCyberSchool, a computer-assisted instruction (CAI) tool available on the Internet, into the curriculum of a senior medical student subinternship in emergency medicine (EM) would improve exam scores and course satisfaction. Methods: Students were prospectively randomized, by four-week blocks, into a CAI group and a no-CAI group. All students were surveyed on previous computer experience and their use and opinion of the EMCyberSchool. Results: Completed data were obtained from 100 of 120 students. Sixty-five percent of the students said they wanted CAI as an adjunct to their course curricula; only 28% actually used the educational tool. The students who used the site rated it useful (4.2/5), easy to use (4.4/5), and easy to access (4.1/5). Of the students who had access, and chose not to use the EMCyberSchool, 77.8% reported not having enough time as the reason for not using the site. The mean exam scores were 72.8% for the students in the CAI group and 68.2% for those in the no-CAI group (p = 0.058). In the CAI group, 77.5% (31/40) of the students rated the course as outstanding or excellent; compared with 66% (33/50) in the no-CAI group (p = 0.23). Conclusions: Although desired, it remains unclear whether CAI on the Internet is a useful adjunct for teaching EM to medical students. [source]

Glossal angiomyoma: Imaging findings and endovascular treatment

Franklin A. Marden MD
Abstract Background. An angiomyoma is an uncommon, benign tumor characterized by numerous vascular channels intermixed with bundles of smooth muscle cells. Oral manifestations are quite rare. We describe for the first time the CT, MRI, and angiographic imaging features and successful preoperative endovascular embolization of an angiomyoma of the tongue. The pathologic findings before and after embolization are also described. Methods and Results. A 25-year-old man was seen with a rapidly enlarging tongue mass. Imaging studies revealed the extent and hypervascular nature of this tumor. The diagnosis of angiomyoma was confirmed by histologic examination. Preoperative embolization proved to be helpful in the surgical management of this lesion. Conclusions. Angiomyoma should be considered in the differential diagnosis of any well-circumscribed, hypervascular, soft tissue tumor in the mouth. In addition, endovascular embolization may be a useful adjunct that facilitates resection. © 2004 Wiley Periodicals, Inc. Head Neck26: 1084,1088, 2004 [source]

Standardized health check data from community-dwelling elderly people: the potential for comparing populations and estimating need

Peter 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]

Enhanced maturation and functional capacity of monocyte-derived immature dendritic cells by the synthetic immunomodulator Murabutide

IMMUNOLOGY, Issue 4 2001
Vincent Vidal
Summary Murabutide is a safe synthetic immunomodulator derived from muramyl dipeptide, the smallest bioactive unit of bacterial peptidoglycan. Although it is well known that muramyl peptides modulate the functions of monocytes/macrophages, their activity on dendritic cells is poorly documented. We thus investigated the effects of Murabutide on immunophenotype, endocytosis, T-cell stimulatory capacity, and cytokine secretion of human monocyte-derived immature dendritic cells (iDCs). We found that Murabutide triggers immunophenotypic changes as upon treatment, iDCs up-regulate the surface expression of the major histocompatibility complex type II molecule human leucocyte antigen-DR, the co-stimulatory molecules CD80, CD86 and CD40 and the differentiation marker CD83, and down-regulate the expression of the mannose receptor. These phenotypic changes are also mirrored by changes in their biological activity. Subsequent to treatment with the synthetic immunomodulator, DC have a decreased endocytic capacity but exhibit enhanced stimulatory capacity for both allogeneic and autologous T cells. In addition, Murabutide-stimulated iDCs have a greater cytostatic activity toward the tumour cell line THP-1. Furthermore, in the presence of Murabutide, DCs transiently increased the release of macrophage inhibitory protein-1,, tumour necrosis factor-, and interleukin-10, whereas the enhanced production of macrophage-colony stimulating factor was sustained over the 3-day period analysed. In addition, Murabutide triggers the phosphorylation of the three classes of mitogen-activated protein kinases in iDCs. Altogether our results demonstrate that Murabutide triggers the maturation and activation of monocyte-derived iDCs. As this immunomodulator is approved for administration in humans, it could be a useful adjunct to boost the efficacy of DC-based vaccines designed against tumours or virus-infected cells. [source]

Immunoperoxidase technique for detecting spirochetes in tissue sections: comparison with other methods

Robert George Phelps MD
Background With the increasing incidence of human immunodeficiency virus (HIV) infection and immunosuppressive therapy, the incidence of syphilis has been increasing. Given the fact that the above conditions may mask or obscure the usual clinical signs and symptoms of syphilis, a means of enhanced detection is essential. Aims,methods The purpose of this study was to determine whether an immunoperoxidase method using an antibody against treponemes would increase the sensitivity and specificity of diagnosis in biopsies of patients with secondary syphilis. This was compared to serology and silver stain in cases of known syphilis. Results Immunoperoxidase for treponemes was at least as sensitive (9/10) as pathology (9/10), and more sensitive than conventional silver stain (6/10) or serology (7/10). Conclusions In those equivocal cases of secondary syphilis, where confirmation is essential, immunoperoxidase for treponemes may be a useful adjunct. [source]

The patient's view on quality of life and eating disorders

Simone de la Rie MA
Abstract Objective: This study investigated the personal views of eating disorder (ED) patients on their quality of life (QOL). Method: The views of 146 current ED patients and 146 former ED patients on their QOL were studied using a self-report questionnaire. Patients were requested to name the most important aspects of their life and they subsequently rated themselves on these aspects. Qualitative analysis clustered items into meaningful categories. Results: A sense of belonging was mentioned most often (93.0%) by the participants. Work or education, health and well-being were also mentioned frequently. Furthermore, participants stated a sense of self, disease-specific psychopathology, life skills, leisure activities, a sense of purpose, financial situation, living condition, and pets. Current ED patients more frequently mentioned disease-specific psychopathology than former ED patients. Current ED patients reported poor QOL on most domains, particularly on self-image and well-being. Former ED patients reported better QOL than current ED patients, but ratings were just above average. Conclusion: The views on QOL of ED patients broadens the scope of relevant domains of QOL. The assessment of these views may be a useful adjunct to the use of standardized QOL measures. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006 [source]

Effectiveness of general practice nurse interventions in cardiac risk factor reduction among adults

Elizabeth Halcomb RN BN(Hons) Grad Cert.
Abstract Background, Cardiovascular disease is the leading cause of death for adults in Australia. In recent years there has been a shift in health service delivery from institutional to community-based care for chronic conditions, including cardiovascular disease. The general practice setting is seen to offer greater flexibility, higher levels of efficiency and more client focused healthcare delivery than is possible in the acute care sector. It has been suggested that practice nurses represent a useful adjunct to current models of cardiovascular disease management. To date, significant descriptive research has been conducted exploring the demographics, roles, educational needs and issues facing practice nurses. However, there is a need to evaluate the effectiveness of practice nurse interventions in terms of patient outcomes, clinician satisfaction and cost-effectiveness. Objectives, This review seeks to present the best available evidence regarding the efficacy of general practice nurse interventions for cardiac risk factor reduction in healthy adults, as well as those with established cardiovascular disease or known cardiac risk factors. Search Strategy, A systematic literature search was performed using Medline (1966 , 2005), CINAHL (1982 ,2005), Cochrane Controlled Trials Register (Issue 4, 2005) and the Joanna Briggs Institute Evidence Library. In addition, the reference lists of retrieved papers, conference proceedings and the Internet, were scrutinised for additional trials. Selection Criteria, This review considered any English language randomised trials that investigated interventions conducted by the practice nurse for cardiovascular disease management or reduction of cardiac risk factors. Interventions conducted by specialist cardiac nurses in general practice were excluded. Outcomes measured included blood pressure, smoking cessation, total cholesterol, exercise, body weight/body mass index and cost-effectiveness. Results, Eighteen trials, reported in 33 papers, were included in the review. Ten trials investigated multifaceted interventions, while the remaining eight trials reported targeted interventions. Of the trials that reported multifaceted interventions, three trials investigated risk reduction in those with established cardiovascular disease, four trials focused on those with known cardiovascular disease risk factors and three trials included the general community. The eight trials which examined the efficacy of targeted interventions focused upon dietary intake (two trials), smoking cessation (three trials), weight reduction (one trial) and physical activity (two trials). The effect of both the multifaceted and targeted interventions on patient outcomes was variable. However, both the multifaceted and targeted interventions demonstrated similar outcome trends for specific variables. Improvements were demonstrated by most studies in blood pressure, cholesterol level, dietary intake and physical activity. The variation in outcome measures and contradictory findings between some studies makes it difficult to draw definitive conclusions. Conclusions, While interventions to reduce cardiovascular disease risk factors have produced variable results, they offer significant potential to assist patients in modifying their personal risk profile and should be developed. The public health importance of these changes is dependant upon the sustainability of the change and its effect on the health outcomes of these individuals. Further well-designed research is required to establish the effectiveness of practice nurse interventions for cardiovascular disease management and risk factor reduction in terms of patient outcomes and cost-effectiveness. [source]

Delirium Severity and Psychomotor Types: Their Relationship with Outcomes after Hip Fracture Repair

Edward Marcantonio MD
OBJECTIVES: To validate the Memorial Delirium Assessment Scale (MDAS) as a measure of delirium severity in a cohort of patients aged 65 and older; to examine the association between severity of delirium and patient outcomes; and to examine the association between psychomotor variants of delirium and each of those outcomes. DESIGN: Prospective assessment of sample. SETTING: Hospital. PARTICIPANTS: One hundred twenty-two older patients (mean age ± standard deviation = 79 ± 8) who had undergone acute hip fracture surgery. MEASUREMENTS: We used standardized instruments to assess prefracture activities of daily living (ADLs), ambulatory status, cognition, and living situation. Postoperatively, each patient was interviewed daily. Delirium was diagnosed using the Confusion Assessment Method (CAM), and delirium severity was measured using the MDAS. The MDAS was also used to categorize the psychomotor types of delirium into "purely hypoactive" or "any hyperactivity." Telephone or face-to-face interviews were conducted at 1 and 6 months to assess survival, ADL function, ambulatory status, and living situation. RESULTS: Of 122 patients, 40% developed CAM-defined delirium. Delirious patients had higher average MDAS scores than nondelirious patients (11.7 vs 2.4, P <.0001). We used the median of the average MDAS score to classify patients into mild or severe delirium. Severe delirium was generally associated with worse outcomes than was mild delirium, and the associations reached statistical significance for nursing home placement or death at 6 months (52% vs 17%, P = .009). Additionally, patients who did not meet full CAM criteria for delirium experienced worse outcomes if they had some symptoms of delirium than if they had no or few symptoms (nursing home placement or death at 6 months: 27% vs 0%, P = .001). Surprisingly, these patients with subsyndromal delirium who did not fulfill CAM criteria for delirium but demonstrated significant delirium symptoms, had outcomes similar to or worse than those with mild CAM-defined delirium. Pure hypoactive delirium accounted for 71% (34/48) of cases and was less severe than was delirium with any hyperactivity (average MDAS score 10.6 vs 14.8, P = .007). In our cohort, patients with pure hypoactive delirium had better outcomes than did those with any hyperactivity (nursing home placement or death at 1 month: 32% vs 79%, P = .003); this difference persisted after adjusting for severity. CONCLUSION: In this study of delirium in older hip fracture patients, the MDAS, a continuous severity measure, was a useful adjunct to the CAM, a dichotomous diagnostic measure. In patients with CAM-defined delirium, severe delirium was generally associated with worse outcomes than was mild delirium. In patients who did not fulfill CAM criteria, subsyndromal delirium was associated with worse outcomes than having few or no symptoms of delirium. Patients with subsyndromal delirium had outcomes similar to patients with mild delirium, suggesting that a dichotomous approach to diagnosis and management may be inappropriate. Pure hypoactive delirium was more common than delirium with any hyperactive features, tended to be milder, and was associated with better outcomes even after adjusting for severity. Future studies should confirm our preliminary associations and examine whether treatment to reduce the severity of delirium symptoms can improve outcomes after hip fracture repair. [source]

Using Q-Methodology to Involve People with Intellectual Disability in Evaluating Person-Centred Planning

Helen Combes
Objectives Person-centred approaches do not easily lend themselves to standard methods of evaluation. This study develops a technique that will involve service users and their circle of support in making individual plans. Methodology Q-methodology is a phenomenological approach, which enables the researcher to co-construct the stories of many people. Two people with learning disabilities and seven members of their circle of support were identified to participate in the study. They attended a stakeholder meeting to identify 36 valued activities. The 16 participants then completed a Q-sort using photographs to represent these activities. These sorts were then interpreted using Q-methodology. Results There were a number of intercorrelations between the card sorts. Principle component analysis showed that two factors accounted for 73% of the variance of the data. The two clusters represented the members of each person's circle of support. Analysis and comparison of the factors have highlighted the similarities and differences between individuals and their circle of support. Conclusions This study shows that Q-methodology is a useful adjunct to person-centred planning. Looking at and interpreting the data, which emerge through Q-methodology, hashighlighted both similarities and individual differences for goal planning. It has also highlighted potential areas for service change and development. Using Q-sorts over time may be a way to demonstrate the subjective change in peoples' values that occur through person-centred planning (PCP). [source]

Safety and efficacy of granulocyte and monocyte adsorption apheresis in patients with active ulcerative colitis: A multicenter study

Takashi Shimoyama
Abstract Active ulcerative colitis (UC) is characterized by activation and infiltration of granulocytes and monocytes/macrophages into the colonic mucosa. The infiltrated leukocytes can cause mucosal damage by releasing degradative proteases, reactive oxygen derivatives, and proinflammatory cytokines. The aim of this trial (conducted in 14 specialist centers) was to assess safety and efficacy of granulocyte and monocyte adsorption apheresis in patients with active UC most of whom were refractory to conventional drug therapy. We used a new adsorptive type extracorporeal column (G-1 Adacolumn) filled with cellulose acetate beads (carriers) of 2 mm in diameter, which selectively adsorb granulocytes and monocytes/macrophages. Patients (n = 53) received five apheresis sessions, each of 60 minutes duration, flow rate 30 ml per minute for 5 consecutive weeks in combination with 24.4 ± 3.60 mg prednisolone (mean ± SE per patient per day, baseline dose). During 60 minutes apheresis, 26% of granulocytes, 19.5% of monocytes and 2% of lymphocytes adsorbed to the carriers. At week 7, 58.5% of patients had remission or improved, the dose of prednisolone was reduced to 14.2 ± 2.25 mg (n = 37). The apheresis treatment was fairly safe, only eight non-severe side effects (in 5 patients) were reported. Based on our results, we believe that in patients with active severe UC, patients who are refractory to conventional drugs, granulocyte and monocyte adsorption apheresis is a useful adjunct to conventional therapy. This procedure should have the potential to allow tapering the dose of corticosteroids, shorten the time to remission and delay relapse. J. Clin. Apheresis. 16:1-9, 2001. © 2001 Wiley-Liss, Inc. [source]

Physical discipline, escalation, and child abuse potential: psychometric evidence for the Analog Parenting Task

Mary Bower Russa
Abstract Data from three studies provide new evidence to support the validity of the Analog Parenting Task (APT) as an instrument to assess risk for harsh, physically aggressive parenting. In this series of studies, there was a strong association between APT scores of expected use and escalation of discipline strategies and self-reported disciplinary attitudes. APT scores were also associated with physical abuse potential as assessed by both a well-established measure of child abuse potential (Child Abuse Potential Inventory) and another instrument designed specifically for use in pre-parent populations (e.g., Adult,Adolescent Parenting Inventory-2). This study provides new psychometric evidence to support the use of the APT to assess harsh parenting. Additionally, these data highlight the connection between acceptance and use of physical disciplinary strategies, propensity for disciplinary escalation, and risk for abuse perpetration. The findings are discussed in the context of Milner's Social Information Processing model [Milner, 2003] of abuse, which suggests that parental selection of disciplinary responding and the monitoring of disciplinary responding are key events in the disciplinary process. The APT may prove a useful adjunct to more commonly used self-report measures to allow for multimethod assessment of risk for punitive parenting. Aggr. Behav. 36:251,260, 2010. © 2010 Wiley-Liss, Inc. [source]

New method for the detection of intraperitoneal free air by sonography: Scissors maneuver

Okkes Ibrahim Karahan MD
Abstract Purpose This study was conducted to investigate the diagnostic value of a new sonographic technique for the detection of intraabdominal free air. Methods Seventy-two patients with a suspected gastrointestinal tract perforation were included in the study and prospectively evaluated by sonography and abdominal and chest radiography for the detection of intraperitoneal free air. A new sonographic technique (the scissors maneuver) was used to detect intraperitoneal free air superficial to the liver; the maneuver consists of applying and then releasing slight pressure onto the abdominal wall with the caudal part of a parasagittaly oriented linear-array probe. The results of the imaging studies were correlated with surgical findings when possible. Results Sixteen patients had a surgically proven gastrointestinal tract perforation causing pneumoperitoneum. Sonography and radiography each showed pneumoperitoneum in 15 patients, with 1 false-negative result for each modality. The sensitivity and specificity values of sonography and radiography were identical; sensitivity was 94% and specificity was 100% for both imaging modalities. The scissors maneuver was positive in all patients with sonographically detected pneumoperitoneum. Conclusions Sonography is an effective tool in the diagnosis of pneumoperitoneum, with sensitivity and specificity equal to those of radiography. The scissors maneuver may be a useful adjunct for improving the diagnostic yield of sonography. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:381,385, 2004 [source]

Three-dimensional sonographic evaluation of the infant spine: Preliminary findings

Jacqueline A. Hughes MBBS
Abstract Purpose The aims of this study were to evaluate normal spinal anatomy in neonates and infants as seen by 3-dimensional sonography (3D US), to determine the value of 3D US in the evaluation of occult spinal dysraphia in infants, and to correlate the findings of 3D US with those of 2-dimensional sonography (2D US) and MRI, when available. Methods We used 2D US and 3D US to examine the lumbosacral spine in infants with cutaneous stigmata, syndromes associated with spinal dysraphia, and abnormal radiographs. We also evaluated, as controls, healthy infants who had no markers of spinal abnormality. 2D sonograms, 3D sonograms, radiographs, and MRI scans, when available, were compared to assess differences in the display of the infant spine. Results In total, we examined 29 infants: 18 subjects and 11 control infants. The correlation between 2D US and 3D US was 100% in the detection of congenital defects of the spinal cord, although 3D US allowed superior visualization of the vertebral bodies and posterior spinal elements. When a gross abnormality of the posterior spinal elements occurred with pathologic overlying soft tissue, interpretation was simpler with MRI than with sonography. Conclusions 3D US is a useful adjunct to 2D US when screening the infant spine for congenital defects, particularly in showing alignment of posterior spinal elements and integrity of vertebral bodies. This ability is important because posterior spinal defects may be associated with underlying spinal cord abnormalities. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 31:9,20, 2003 [source]

Value of p63 and podoplanin (D2-40) immunoreactivity in the distinction between primary cutaneous tumors and adenocarcinomas metastatic to the skin: a clinicopathologic and immunohistochemical study of 79 cases

Jose A. Plaza
The distinction of metastatic carcinomas to the skin from poorly differentiated primary cutaneous carcinomas and sometimes primary benign adnexal tumors can pose a significant diagnostic challenge. The purpose of this study was to evaluate the role of p63 and podoplanin (D2-40) immunoreactivity for separating primary skin tumors vs. cutaneous metastases of carcinomas from internal organs. Thirty seven primary tumors and 42 cutaneous metastatic adenocarcinomas were evaluated. The 37 primary cutaneous tumors included 14 cases of benign adnexal tumors, 9 malignant skin adnexal neoplasms, and 14 primary squamous and basal cell carcinomas. The 42 metastatic adenocarcinomas all corresponded to metastases from patients with a well-documented history of a primary tumor at another location. We found variable positivity with podoplanin in all primary cutaneous neoplasms including spiradenoma (6/6), hidradenoma (2/4), cylindroma (3/3), desmoplastic trichilemmoma (1/1), poorly differentiated squamous cell carcinoma (4/4), sebaceous carcinoma (1/1), basal cell carcinoma (4/10), trichilemmal carcinoma (2/2), eccrine carcinoma (3/3), microcystic adnexal carcinoma (1/1), adnexal carcinoma NOS (1/1), and porocarcinoma (1/1). In contrast, all metastatic carcinomas were negative (0/42) for podoplanin. In regards to p63, all cases of primary cutaneous tumors were positive for p63 (37/37); in contrast, all cutaneous metastatic carcinomas were negative (0/42). Sensitivity, specificity, and positive and negative predictive values of podoplanin and p63 immunoreactivity to separate primary skin neoplasms from metastatic carcinomas were 78.4, 100.0, 100.0 and 84.0% for podoplanin, respectively, and 100.0, 100.0, 100.0 and 100.0% for p63, respectively. The differences in p63 and podoplanin immunohistochemical expression between primary skin tumors and metastatic carcinomas to the skin were statistically significant (p < 0, 0001). The results of our study suggest that the combined expression of p63 and podoplanin are a useful adjunct for the diagnosis of skin tumors in the clinical setting of a questionable metastasis and may be relatively specific for distinguishing primary skin tumors from metastatic carcinomas to the skin. Plaza JA, Ortega PF, Stockman DL, Suster S. Value of p63 and podoplanin (D2-40) immunoreactivity in the distinction between primary cutaneous tumors and adenocarcinomas metastatic to the skin: a clinicopathologic and immunohistochemical study of 79 cases. [source]

Immunohistochemical characteristics of melanoma

Steven J. Ohsie
Melanoma has a wide spectrum of histologic features which mimic epithelial, hematologic, mesenchymal, and neural tumors. Immunohistochemistry has been the primary tool to distinguish melanomas from these other tumors; it has also been studied for use as an adjunct to distinguish benign and malignant melanocytic tumors and to elucidate prognosis. Furthermore, there has been extensive effort to find a suitable marker to differentiate spindle cell and desmoplastic melanoma from other tumors. We have reviewed the literature investigating melanocytic differentiation markers, proliferation markers, immunomodulatory markers, signaling molecules, and nerve growth factors and receptors. Despite the proliferation of immunohistochemical markers, S-100 remains the most sensitive marker for melanocytic lesions, while markers such as HMB-45, MART-1/Melan-A, tyrosinase, and MITF demonstrate relatively good specificity but not as good sensitivity as S-100. No marker has proven useful in distinguishing spindle cell and desmoplastic melanomas from other tumors. Ki67 remains the most useful adjunct in distinguishing benign from malignant melanocytic tumors. None of the markers reviewed has been shown conclusively to have prognostic value for melanocytic neoplasms. [source]

Androgen Receptor Expression Helps to Differentiate BCC From Trichoblastoma and Trichoepithelioma

L. Izikson
Histological differentiation between basal cell carcinoma and benign trichoblastic neoplasms such as trichoepithelioma and trichoblastoma can be difficult on small biopsies. Therefore, several attempts have been made to identify immunohistochemical differences between these entities. Recent studies showed androgen receptor expression in a number of mature epithelial structures in the skin and in epithelial neoplasms including basal cell carcinoma. In contrast, androgen receptor expression was absent in mature hair follicles or the few trichogenic neoplasms studied to date. These findings suggested that androgen receptor expression might be a useful adjunct in the histological differential diagnosis between basal cell carcinoma and benign trichoblastic neoplasms. Therefore, we performed immunohistochemical analysis of androgen receptor expression in 32 basal cell carcinomas and 10 benign trichoblastic tumors (6 trichoepitheliomas and 4 trichoblastomas). In our study, expression of androgen receptor was detected in 78% of basal cell carcinomas. None of the trichoblastic tumors showed any androgen receptor immunoreactivity. These results confirm the lack of androgen receptor expression in benign trichoblastic neoplasms and indicate that finding of androgen receptor expression points to basal cell carcinoma as the most likely diagnosis. [source]

Preliminary evaluation of a scale to assess cognitive function in adults with Down's syndrome: the Prudhoe Cognitive Function Test

D. W. K. Kay
Abstract Background In the clinical diagnosis of dementia in Down's syndrome (DS), it may be difficult to distinguish between cognitive deterioration and the various degrees of pre-existing intellectual disability (ID). Serial measurements of both cognitive function and behaviour are required. The aim of the present study was to evaluate the performance of non-demented adults with DS on a subject-directed instrument, the Prudhoe Cognitive Function Test (PCFT), preliminary to its serial use in a prospective study. Methods From 1985 to 1986, 85 non-demented hospitalized adults with DS were interviewed using the PCFT. The Adaptive Behavior Scale (ABS) was administered to the carers. The subjects' levels of ID (graded from mild through moderate, severe and profound to untestable) were based on their scores on the Stanford,Binet Intelligence Scale, as reported in the medical records, and the relationship between level of disability and performance on the PCFT and ABS, and their respective domains, was examined. Results Both scales produced a wide range of scores and the correlation between them was highly significant. Both scales correlated highly significantly with the degree of ID, but more subjects with high levels (i.e. profound to untestable) of disability obtained very low or zero scores on the PCFT and its domains than on the ABS. Conclusions The PCFT provides a reliable quantitative measure of cognitive function in subjects with DS, and could be a useful adjunct to the diagnosis of dementia in prospective studies. However, the almost uniformly low scores obtained by those with high levels of ID suggests that its power to detect cognitive decline will be limited to those who are less disabled, while the ABS may be more useful than the PCFT in detecting deterioration in people with profound ID. [source]

MRI of the pelvic ring joints postpartum: Normal and pathological findings

Susanne Wurdinger MD
Abstract Purpose To assess the joints of the pelvic ring postpartum and to discern normal postpartum findings and pathologic lesions using MRI. Materials and Methods MR images were obtained in six women with severe pelvic ring pain after delivery, in 13 women after uncomplicated vaginal delivery, and in 11 healthy, nulliparous non-pregnant volunteers. Distances of the pubic gap, signal intensities of the pubic cartilage, and signal changes of the pelvic ring bones were determined and evaluated. Results Both postpartum groups had significantly larger distances of the interpubic gap compared to the nulliparous group (P = 0.0002). The mean signal intensity of cartilage of the symphysis pubis was significantly different on the T1-weighted and T2-weighted MR images in postpartum women compared to nulliparous women (P = 0.001), indicating a higher water content of the pubic cartilage. 13 of all 19 postpartum women had bruises of parasymphyseal pubic bones. One pubic symphysis rupture and one sacral stress fracture were detected in two symptomatic women. Conclusion MR imaging is a useful adjunct to clinical examination to identify patients with lesions of the pelvic ring postpartum. MRI of the pelvic ring of asymptomatic postpartum women can demonstrate signal changes of the pubic cartilage and small bruises of the pubic bones. J. Magn. Reson. Imaging 2002;15:324,329. © 2002 Wiley-Liss, Inc. [source]

Ultrafast MRI of the fetus

Christine M Glastonbury
SUMMARY During the last decade there has been increasing interest in MRI for the evaluation of ultrasound-detected fetal abnormalities. Motion artefacts previously precluded detailed imaging, but this is now possible using single-shot rapid acquisition sequences. These ultrafast techniques with subsecond images capture ,snap-shot' views of the fetus. By virtue of the infinitely long relaxation time (TR) these images are heavily T2-weighted so that fluid around and within the fetus delineates the anatomy. Currently, fetal MRI has shown to be most beneficial in the investigation of cerebral abnormalities suspected from sonography, and in the detection of subtle associated anomalies. It clearly has a role in the evaluation of complex somatic abnormalities, and is helpful in the evaluation of fetuses prior to surgery. We present a pictorial review of our experience with single-shot fast spin-echo (SSFSE) imaging, demonstrating normal anatomy of the fetal brain and body. In addition we present cerebral and somatic abnormalities to illustrate cases where we have found fetal MRI to be a useful adjunct to sonography. [source]

G1 cyclins in oral epithelial dysplasia

R. J. Oliver
Abstract: The G1 cyclins, D1, D3 and E, were investigated in 38 lesions of oral epithelial dysplasia from the floor of the mouth or the lateral border of the tongue. Their immunohistochemical expression was observed and compared with that of Ki-67 and with the degree of dysplasia assessed by the semi-objective technique of Smith & Pindborg. Antibody labelled cells were quantified and expressed as a percentage (LI%) of the total nucleated cell population and per mm basement membrane length (LI/mm). The labelling indices of all of the antibodies were high and quantitatively similar. There were no significant correlations with the degree of dysplasia assessed by the atypia scores. There was a correlation between labelling indices for the various antibodies expressed as LI/mm but little correlation between the indices expressed as LI%. The distribution of the D cyclins was similar to that of Ki-67 with relatively few of the basal cells demonstrating immunoreactivity. The reasons for this are discussed in the paper. Some cross-reactivity was observed with the cyclin antibodies. We conclude that the antibodies against the cyclins used in the present study are not a useful adjunct in the study of the cell kinetics of oral epithelial dysplasia. [source]