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Patient Acceptance (patient + acceptance)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Diabetes	7%
15 Other Subdomains	86%

Selected Abstracts

Cold Air Analgesia in Photodynamic Therapy of Basal Cell Carcinomas and Bowen's Disease: An Effective Addition to Treatment: A Pilot Study

DERMATOLOGIC SURGERY, Issue 1 2004
FACD, John Pagliaro MB
Background. There is considerable interpatient variability in pain tolerance during and after treatment of skin cancer with photodynamic therapy (PDT). Additionally, erythema and edema are common, with mild crusting and healing over 1 to 2 weeks. Objective. To determine whether concurrent cold air analgesia improves the tolerability of PDT. Method. Twenty-six patients with two similar superficial skin cancers were treated with PDT. One lesion was treated with cold air analgesia and the other without. Patients rated their pain during treatment using the Wong Baker Faces Pain Scale and detailed duration of posttreatment pain. At week 2, the inflammatory response was assessed. Result. A statistically significant difference in the analgesia group was shown with respect to the mean duration of pain and the level of erythema after the first treatment as well as pain scores during the second treatment. Conclusion. Patient acceptance of PDT for treatment of nonmelanoma skin cancer is improved with lessened morbidity assessed with concurrent use of cold air analgesia to the treatment field. [source]

Analgesia before a spinal block for femoral neck fracture: fascia iliaca compartment block

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009
M. J. YUN
Background: In this prospective randomized study, the authors compared the analgesic effect of a fascia iliaca compartment (FIC) block with that of intravenous (i.v.) alfentanil when administered to facilitate positioning for spinal anaesthesia in elderly patients undergoing surgery for a femoral neck fracture. Methods: The 40 patients were randomly assigned to one of two groups, namely, the FIC group (fascia iliaca compartment block, n=20) and the IVA group (intravenous analgesia with alfentanil, n=20). Group IVA patients received a bolus dose of i.v. alfentanil 10 ,g/kg, followed by a continuous infusion of alfentanil 0.25 ,g/kg/min starting 2 min before the spinal block, and group FIC patients received a FIC block with 30 ml of ropivacaine 3.75 mg/ml (112.5 mg) 20 min before the spinal block. Visual analogue pain scale (VAS) scores, time to achieve spinal anaesthesia, quality of patient positioning, and patient acceptance were compared. Results: VAS scores during positioning (mean and range) were lower in the FIC group than in the IVA group [2.0 (1,4) vs. 3.5 (2,6), P=0.001], and the mean (± SD) time to achieve spinal anaesthesia was shorter in the FIC group (6.9 ± 2.7 min vs. 10.8 ± 5.6 min; P=0.009). Patient acceptance (yes/no) was also better in the FIC group (19/1) than in the IVA group (12/8)(P=0.008). Conclusions: An FIC block is more efficacious than i.v. alfentanil in terms of facilitating the lateral position for spinal anaesthesia in elderly patients undergoing surgery for femoral neck fractures. [source]

Patient acceptance and clinical impact of Bravo monitoring in patients with previous failed catheter-based studies

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009
R. SWEIS
Summary Background, Standard pH monitoring is performed over 24 h with a naso-oesophageal catheter (C-pH). Limitations include naso-pharyngeal discomfort, nausea and social embarrassment resulting in reduced reflux-provoking activities. Recently a catheter-free pH-monitoring technique has become available. The tolerability and diagnostic yield of this system in patients who failed standard monitoring remain unknown. Aim, To examine the tolerability and diagnostic outcome of catheter-free pH-monitoring technique in patients who failed standard monitoring. Methods, Patients referred for C-pH and catheter-free pH monitoring completed a tolerability questionnaire. Acid exposure in the distal oesophagus and symptom index (SI) were reviewed. Results, Over 4 years, 883/1751 (50%) of patients with typical reflux symptoms referred for C-pH were diagnosed with gastro-oesophageal reflux disease (GERD) based on a pathological percentage time acid exposure (%time pH <4);134 (8%) patients failed C-pH and, of these, 129 successfully completed 2-day catheter-free pH monitoring. Ninety-eight (76%) of these patients had a pathological percentage pH <4 on either day compared with 49/102 (49%) of contemporaneous C-pH patients (P < 0.01). There was no difference in SI for heartburn (35% vs. 42%; P = 0.49). The questionnaire demonstrated a preference for catheter-free pH monitoring (96%) with less restriction in activities of daily living, naso-pharyngeal discomfort, dysphagia and chest pain. Conclusions Tolerance and satisfaction with catheter-free pH monitoring are high in patients who had previously failed C-pH; catheter-free pH monitoring assists the definitive diagnosis of GERD in this group. [source]

Clinical trial: sodium phosphate tablets are preferred and better tolerated by patients compared to polyethylene glycol solution plus bisacodyl tablets for bowel preparation

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2007
G. R. LICHTENSTEIN
Summary Background, Patient acceptance of bowel preparation can affect colon cancer screening compliance. Aim, To compare patient acceptance, preference and tolerability of 32-sodium phosphate tablets vs. 2L polyethylene glycol solution plus 4 bisacodyl tablets for bowel preparation. Methods, A prospective, randomized, investigator-blinded, multicentre trial was performed. Results were based on responses to a patient questionnaire. Results, 411 patients (205 sodium phosphate; 206 polyethylene glycol plus bisacodyl) completed the study preparation and patient questionnaire prior to colonoscopy. More patients receiving sodium phosphate vs. polyethylene glycol plus bisacodyl found it easy to take (77% vs. 42%), reported it to be without taste (47% vs. 6%), found it easy to take with respect to volume of liquid prescribed (72% vs. 27%) and indicated they would take the same preparation again in the future (96% vs. 74%, P < 0.0001 for all). Fewer patients receiving sodium phosphate vs. polyethylene glycol plus bisacodyl had to take time off work or change ordinary activities to take the study preparation (18% vs. 52%, P < 0.0001). Nausea, vomiting, bloating and abdominal pain were reported less frequently with sodium phosphate (P < 0.0013). Conclusion, The 32-tablet sodium phosphate dosing regimen was easier to take and better tolerated, when compared to 2L polyethylene glycol plus bisacodyl tablets for bowel preparation. [source]

DIADEM: implementation of a comprehensive disease management programme for type 2 diabetes

PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 3 2005
Dr S Luzio PhD Clinical Trials Manager
Abstract The purpose of the study was to evaluate the feasibility and acceptance of an IT-based diabetes disease management programme. The study was performed at two test sites in Aachen (Germany) and Cardiff (UK) including 166 and 137 patients respectively. The study focused on the technical feasibility of a web-based communication platform and its acceptance among medical professionals, the patient acceptance of entering self-measured data via phone and of service-centre support, the acceptance of implementing quality management measures, and the effects of all these measures on glycaemic control. The maximum programme duration was four months at Aachen and six months at Cardiff. The main outcomes were utilisation data, and satisfaction of both patients and physicians with the different components of DIADEM. HbA1c concentrations improved significantly from 7.1±1.0% to 6.8±1.1% in Aachen and from 7.7±1.0% to 7.1±1.1% in Cardiff (each p<0.001). The platform as a hosted ASP (application service provider) solution was accessible using a standard Internet enabled PC. Following training, a fast and efficient introduction of the software to professional users was obtained. Patient acceptance was very high both in terms of utilisation of the system (13 000 data entries performed during 6800 calls) and in terms of patient satisfaction assessed by a patient survey (93% very satisfied or satisfied). Patients strongly preferred a DTMF (dual tone multi-frequency) interface entering data by telephone key-pad rather than voice recognition. This study showed that an IT-based diabetes disease management service improved glycaemic control in patients with type 2 diabetes and could find acceptance by patients and professionals if convenient pathways for data entry and transmission are provided. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2006
M. Johansson
Background: Laparoscopic cholecystectomy has been performed as a day-care procedure for many years. Few studies have been conducted with primary focus on patient acceptance and preferences in terms of quality of life for this practice compared with overnight stay. Methods: Data from 100 patients with symptomatic gallstones randomized to laparoscopic cholecystectomy performed either as a day-care procedure or with overnight stay were analysed. Complications, admissions and readmissions, quality of life and health economic aspects were assessed. Two instruments were used to assess quality of life, the Hospital Anxiety and Depression Scale (HADS) and the Psychological General Well-Being Index (PGWB). Results: Forty-eight (92 per cent) of 52 patients in day-care group were discharged 4,8 h after the operation. Forty-two (88 per cent) of 48 in the overnight group went home on the first day after surgery. The overall conversion rate was 2 per cent. Two patients had complications after surgery, both in the day-care group. No patient in either group was readmitted. There was no significant difference in total quality of life score between the two groups. The mean direct medical cost per patient in the day-care group (,3085) was lower than that in the overnight group (,3394). Conclusion: Laparoscopic cholecystectomy can be performed as a day-case procedure with a low rate of complications and admissions/readmissions. Patient acceptance in terms of quality of life variables is similar to that for cholecystectomy with an overnight stay. The day-care strategy is associated with a reduction in cost. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Procedural pain of an ultrasound-guided brachial plexus block: a comparison of axillary and infraclavicular approaches

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010
B. S. FREDERIKSEN
Background: Ultrasound (US)-guided infraclavicular (IC) and axillary (AX) blocks have similar effectiveness. Therefore, limiting procedural pain may help to choose a standard approach. The primary aims of this randomized study were to assess patient's pain during the block and to recognize its cause. Methods: Eighty patients were randomly allocated to the IC or the AX group. A blinded investigator asked the patients to quantify block pain on a Visual Analogue Scale (VAS 0,100) and to indicate the most unpleasant component (needle passes, paraesthesie or local anaesthetics injection). Sensory block was assessed every 10 min. After 30 min, the unblocked nerves were supplemented. Patients were ready for surgery when they had analgesia or anaesthesia of the five nerves distal to the elbow. Preliminary scan time, block performance and latency times, readiness for surgery, adverse events and patient's acceptance were recorded. Results: The axillary approach resulted in lower maximum VAS scores (median 12) than the infraclavicular approach (median 21). This difference was not statistically significant (P=0.07). Numbers of patients indicating the most painful component were similar in both groups. Patients in either group were ready for surgery after 25 min. Two patients in the IC group and seven in the AX group needed block supplementation (n.s.). Block performance times and number of needle passes were significantly lower in the IC group. Patients' acceptance was 98% in both groups. Conclusions: We did not find significant differences between the two approaches in procedural pain and patient's acceptance. The choice of approach may depend on the anaesthesiologist's experience and the patient's preferences. [source]

A comparison of ultrasound-guided supraclavicular and infraclavicular blocks for upper extremity surgery

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009
Z. J. KOSCIELNIAK-NIELSEN
Background: Ultrasound (US)-guided supraclavicular or infraclavicular blocks are commonly used for upper extremity surgery. The aims of this randomized study were to compare the block performance and onset times, effectiveness, incidence of adverse events and patient's acceptance of US-guided supraclavicular or infraclavicular blocks. We hypothesized that the supraclavicular approach, being more superficial and easier to visualize using a 10 MHz transducer, will produce a faster and a more extensive sensory block. Methods: One hundred and twenty patients were randomized to two equal groups: supraclavicular (S) and infraclavicular (I). Each patient received a mixture containing equal volumes of ropivacaine 7.5 mg/ml and mepivacaine 20 mg/ml with adrenaline 5 ,g/ml, 0.5 ml/kg body weight (minimum 30 ml, maximum 50 ml). The sensory score (anaesthesia , 2 points, analgesia , 1 point and pain , 0 point) of the seven terminal nerves was assessed every 10 min. Patients were declared ready for surgery when they had an effective surgical block , anaesthesia or analgesia of the five nerves below the elbow. Thirty minutes after the block, the unblocked nerves were supplemented. The block performance and latency times, surgical effectiveness, adverse events and patient's acceptance were recorded. Results: Significantly more patients in the I group were ready for surgery 20 and 30 min after the block. The mean block performance time was 5.7 min in the S group and 5.0 min in the I group (NS). Block effectiveness was superior in the I group: 93% vs. 78% in the S group (P=0.017). The S group patients had a significantly poorer block of the median and ulnar nerves, but a better block of the axillary nerve. Sensory scores at 10, 20 and 30 min were not significantly different. Thirty-two patients in the S group vs. nine patients in the I group experienced transient adverse events (P<0.0001). Patients' acceptance of the block was similar in both groups. Conclusions: Infraclavicular block had a faster onset, better surgical effectiveness and fewer adverse events. Block performance time and patients' acceptance of the procedure were similar in both groups. [source]

Minimal-Scar Segmental Extraction of Lipomas: Study of 122 Consecutive Procedures

DERMATOLOGIC SURGERY, Issue 1 2005
Rajiv Y. Chandawarkar MD
Background Surgical extirpation of lipomas that occur in cosmetically conspicuous areas of the body leaves a visible scar that is usually disfiguring. Minimal-scar segmental extraction (MSE) employs a much smaller incision and extraction and is particularly useful in exposed parts of the body. It can be easily performed in an office setting. Objective The objective of this study was to evaluate the merits of MSE in clinical practice. Unlike other reports in the literature that describe, anecdotally, minimally invasive methods of lipoma removal, our study examined a new method by carefully measuring the results in a larger group of consecutive patients treated using this technique. Materials and Methods A retrospective study was performed using data from 91 consecutive patients with a total of 122 lipomas that were treated using MSE. MSE of lipomas consists of a small stab incision and blind dissection of the tumor followed by its extraction in a segmental fashion. This procedure involves small instrumentation, minimal dissection with preservation of contour, and complete removal of the lipoma, including substantial portions of the capsule. Clinical data, including complications, outcomes, and recurrence rates, were recorded. Results The procedure was well tolerated by patients, who were pleased with the results, particularly the small scar. The incidence of complications was 1.6% (n= 2) and consisted of hematoma (n= 1) and seroma (n= 1). The recurrence rate was 0.8% (n= 1). No long-term morbidity was noted. Conclusions The technical ease with which the MSE can be performed, coupled with a low recurrence rate, makes it a very cost-effective operation. The smaller postoperative scars, rapid healing, and low morbidity allow for better patient acceptance. We recognize the advantages and limitations of this procedure and encourage its use in selected patients. RAJIV Y. CHANDAWARKAR, MD, PEDRO RODRIGUEZ, MD, JOHN ROUSSALIS, MD, AND M. DEVIPRASAD TANTRI, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source]

Treatment of Facial Telangiectasia With Variable-Pulse High-Fluence Pulsed-Dye Laser: Comparison of Efficacy with Fluences Immediately Above and Below the Purpura Threshold

DERMATOLOGIC SURGERY, Issue 7 2003
Murad Alam MD
Background. Pulsed-dye laser treatment has been shown to be highly effective for the treatment of facial telangiectasia. Posttreatment purpura after such treatment has limited patient acceptance of the procedure. Objective. To determine whether purpura-free treatment with recently introduced variable-pulsed pulsed-dye lasers can effectively reduce facial telangiectasia. Methods. This was a prospective, randomized, controlled, nonblinded trial. Eleven patients received variable-pulse pulsed-dye laser treatment with and without induction of purpura. Telangiectasia were graded on a "telangiectasia density scale," on which a 1 signified extremely fine, sparsely distributed telangiectasia, and 5 referred to thick, ropelike telangiectasia covering the affected area. For each subject, two areas on either side of the facial midline with equivalent telangiectasia density ratings were randomized to the purpura and purpura-free treatment groups, respectively. All treatments used a 7-mm spot size and a 10-ms pulse duration. The fluence associated with the purpura threshold for each patient was determined in test areas. Purpura-free treatment entailed a fluence 1.0 J/cm2 less than the purpura threshold, and purpura-level treatment entailed a fluence 0.5 J/cm2 greater than the threshold. Results. Six weeks after a single purpura-free treatment, mean telangiectasia ratings were reduced from 2.7 to 2.4. Purpura-level treatments resulted in a decrease to 1.4 from the same baseline. Thicker, denser telangiectasia appeared to benefit more from purpura-level treatment (a mean telangiectasia density scale reduction of 1.7) than finer, sparser telangiectasia (a mean reduction of 0.8). In 81% of cases, both investigators and patients rated the side treated with purpura as undergoing a greater reduction in telangiectasia density. Conclusion. Although facial telangiectasia do improve after a single purpura-free treatment with the variable-pulse pulsed-dye laser, they improve more after purpura is induced. Purpura-free and purpura-level treatments may be close to equivalent for treating fine telangiectasia, but purpura-level treatments have a distinct advantage for treating thicker telangiectasia. Significantly, the variable-pulse pulsed-dye laser offers patients the option of effective treatment of some telangiectasia without bruising. [source]

Complications of Expanded Polytetrafluoroethylene (e-PTFE) Facial Implant

DERMATOLOGIC SURGERY, Issue 9 2001
Harold J. Brody MD
Implantation of the expanded polytetrafluoroethylene (e-PTFE) implant to achieve correction of nasolabial folds or thinning lip has been fraught with complications in spite of patient acceptance since its introduction in 1997. The four most frequent postoperative complications are extrusion, movement, infection, and swelling. In examination of 86 insertions of the 3.2 mm tubular implants, these sequelae are generally manageable for the physician and patient. If the patient understands possible courses of healing, both physician and patient satisfaction may be achieved. [source]

A primer of endometrial cytology with histological correlation

DIAGNOSTIC CYTOPATHOLOGY, Issue 12 2007
John A. Maksem M.D
Abstract Cytology is an effective method for assessing benign endometrium and for discovering premalignant and malignant endometrial states. In addition, it is useful for diagnosing non-neoplastic abnormalities of the endometrium. This overview compares endometrial cytology to endometrial histology for a variety of benign, abnormal non-neoplastic, and neoplastic conditions; and, discusses both diagnostic criteria and pitfalls in the assessment of endometrial brushings specimens. It also makes an attempt to estimate levels of confidence in endometrial cytodiagnosis. When endometrial brushing is used in conjunction with other diagnostic techniques such as ultrasonography/sonohysterography or hysteroscopy, cytology becomes a sensitive case finding technique that shows good patient acceptance (because of a significant decrease in procedure-associated pain) and high diagnostic yield. Diagn. Cytopathol. 2007;35:817,844. © 2007 Wiley-Liss, Inc. [source]

Sustained ophthalmic in situ gel of ketorolac tromethamine: rheology and in vivo studies

DRUG DEVELOPMENT RESEARCH, Issue 6 2009
A.S. Manjappa
Abstract Most ocular diseases are treated with topical eye drops. The poor bioavailability and therapeutic response exhibited by these conventional eye drops due to rapid precorneal elimination of the drug may be overcome by the use of in situ gelling systems that are instilled as drops into the eye and undergo a sol-to-gel transition in the cul-de-sac. The present work describes the formulation and evaluation of an ophthalmic delivery system of the nonsteroidal anti-inflammatory drug (NSAID), ketorolac tromethamine, based on the concept of pH-triggered in situ gelation. Polyacrylic acid (Carbopol® 934) was used as the gelling agent in combination with hydroxypropylmethylcellulose (Methocel E15LV), which acted as a viscosity enhancer. The prepared formulations were characterized for clarity, pH, drug content, rheology, and in vivo drug release. Clarity, pH, and drug content of the developed formulations were found to be satisfactory. The developed formulation showed pseudo-plastic rheology. The formulation with benzalkonium chloride and edetate disodium improved the rate of corneal absorption but not the extent. The developed formulation is a viable alternative to conventional eye drops by virtue of its ability to enhance bioavailability through its longer precorneal residence time and ability to sustain drug release. Also importantly is the ease of instillation afforded and decreased frequency of instillation resulting in better patient acceptance. Drug Dev Res, 2009. © 2009 Wiley-Liss, Inc. [source]

Influence of needle size on metabolic control and patient acceptance

EUROPEAN DIABETES NURSING, Issue 2 2007
G Kreugel RN, MSc Clinical Nurse Specialist in Diabetes
Abstract Aim: To investigate whether the length of the needle used for intermittent subcutaneous insulin administration affects metabolic control, injection-related side effects and patient preference. Method: In a crossover study, 68 patients with type 1 and type 2 diabetes, body mass index , 18 kg/m2, were randomised into two groups; 52 patients completed the trial. Patients in group A used a 5 mm needle for their insulin injections over a period of 13 weeks, then switched to a longer needle (8 or 12 mm). Patients in group B used the needles in reverse order. Patients were re-assessed at 26 weeks. Primary endpoints were insulin doses, and frequency and severity of hypoglycaemic events. Secondary endpoints were patient preference and frequency of injection-related bruising, bleeding, insulin leakage and pain. Results: A total of 52 patients completed the study. No change in the mean glycosylated haemoglobin (HbA1c) level was found in group B (baseline, 7.41%; 13 weeks, 7.38%; 26 weeks, 7.34%), whereas a small but significant rise in mean HbA1c level was observed in group A after returning to the longer needle (baseline, 7.67%; 13 weeks, 7.65%; 26 weeks, 7.87%: p<0.05). There were no significant changes in the amount of insulin injected, frequency or severity of hypoglycaemic events or insulin leakage in either group. The 5 mm needle was associated with a significant decrease in bleeding, bruising and pain (p<0.05). Most patients (86%) showed a preference for the 5 mm needle (p<0.05).Conclusion: For insulin injection, a 5 mm needle length is associated with unchanged HbA1c levels, unchanged frequency or severity of hypoglycaemic events and less discomfort for patients compared with 8 or 12 mm needles. The use of 5 mm needles is as safe as 8 or 12 mm needles. Further research is advisable involving thin and obese patients using 5 mm needles, in order for shorter needles to be recommended as standard practice. Copyright © 2007 FEND [source]

MR colonography without bowel purgation for the assessment of inflammatory bowel diseases: Diagnostic accuracy and patient acceptance

INFLAMMATORY BOWEL DISEASES, Issue 8 2007
Jost Langhorst MD
Abstract Background: The purpose of this pilot study was to assess the diagnostic accuracy of MR colonography (MRC) without bowel cleansing regarding its ability to quantify inflammatory bowel disease (IBD). In addition, patient acceptance was compared with conventional colonoscopy (CC). Methods: In all, 29 patients with IBD (17 ulcerative colitis; 12 Crohn's disease) were included. While CC was performed after bowel cleansing as the gold standard, MRC was based on a fecal tagging technique and performed 48,72 hours prior to CC. The presence of inflammation in each of 7 ileocolonic segments was rated for every procedure. Patients evaluated both modalities and dedicated aspects of the examination according to a 10-point-scale (1 = good, 10 = poor acceptance). Furthermore, preferences for future examinations were investigated. Results: Inflammatory segments were found by means of CC in 23 and by MRC in 14 patients. Overall sensitivity and specificity of MRC in a segment-based detection were 32% and 88%, respectively. Concerning severely inflamed segments, sensitivity increased to 53% for MRC. Overall acceptance of CC was significantly higher compared to MRC (mean value (mv) for MRT = 6.0; CC = 4.1; P = 0.003). For MRC, the placement of the rectal tube (mv = 7.3), and for CC bowel purgation (mv = 6.5), were rated as the most unpleasant. A total of 67% of patients voted for CC as the favorable tool for future examinations. Conclusions: The presented data indicate that ,fecal tagging MRC' is not suitable for an adequate quantification of inflammatory diseases of the large bowel. Furthermore, overall acceptance of endoscopic colonoscopy was superior to MRC. (Inflamm Bowel Dis 2007) [source]

Rubber dam usage for endodontic treatment: a review

INTERNATIONAL ENDODONTIC JOURNAL, Issue 11 2009
I. A. Ahmad
Abstract Rubber dam has been available to the dental profession for over 140 years. During this time, the use of rubber dam has been perfected, universally taught and recommended by professional organizations. Unfortunately, its consistent use has been rejected by many in the profession. The literature suggests that rubber dam is not used routinely by dental practitioners for root canal treatment. Many unfounded reasons have been cited for its lack of use, including concerns over patient acceptance, time required for application, cost of equipment and materials, insufficient training, difficulty in use and low treatment fees. Failure to use rubber dam has been shown to influence the choice of root canal irrigant, has a negative impact on treatment outcome and places the patient at risk of swallowing or aspirating materials and instruments. Methods to popularize rubber dam amongst general practitioners are discussed. [source]

Analgesia before a spinal block for femoral neck fracture: fascia iliaca compartment block

Do Patients Accept Implantable Atrial Defibrillation Therapy?

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2004
Results from the Patient Atrial Shock Survey of Acceptance, Tolerance (PASSAT) Study
Introduction: The Medtronic Jewel AF 7250 is an implantable cardioverter defibrillator with atrial and ventricular therapies (ICD-AT). The ICD-AT is effective in managing atrial tachyarrhythmias (atrial fibrillation [AF]), but patient acceptance remains an issue. This aim of this study was to measure ICD-AT acceptance. Methods and Results: ICD-AT acceptance was evaluated in 96 patients enrolled in the "Jewel AF-AF-Only Study" for ,3 months of follow-up (mean 19 months). Patients were mostly men (72%; age 65 ± 12 years). Clinical data and a written survey (75% response rate) were used to quantify demographics, AF frequency and symptoms, atrial defibrillation therapy, quality of life (QOL), psychosocial distress, and ICD-AT therapy acceptance. From implant to survey, AF symptom and severity scores decreased by 18% (P , 0.05), and QOL (SF-36) scores increased by 15% to 50% (P , 0.05). ICD-AT therapy acceptance was high, with 71.3% of patients scoring in the 75th percentile on the Florida Patient Acceptance Survey. ICD-AT acceptance was correlated with the Physical Component Scale and Mental Health Component Scale scores of the SF-36 (r = 0.28 and 0.35, respectively). ICD-AT acceptance was negatively correlated with depressive symptomatology (r =,0.59), trait anxiety (r =,0.48), illness intrusiveness (r =,0.55), and AF symptom and severity scores (r =,0.26). ICD-AT acceptance did not correlate with preimplant cardioversions, number of atrial shocks, AF episodes detected by the device, or device implant duration. Conclusion: Most patients accepted ICD-AT therapy. Patients were more likely to accept ICD-AT if they had less psychosocial distress, greater QOL, and lower AF symptom burden. (J Cardiovasc Electrophysiol, Vol. 15, pp. 286-291, March 2004) [source]

Clinical trial: sodium phosphate tablets are preferred and better tolerated by patients compared to polyethylene glycol solution plus bisacodyl tablets for bowel preparation

Ultrasound control for presumed difficult epidural puncture

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2001
T. Grau
Background: The efficacy of epidural anaesthesia depends on the accurate identification of the epidural space (ES). Abnormal anatomical conditions may make the procedure difficult or impossible. The aim of this study was to investigate whether pre-puncture ultrasound examination of the spinal anatomy might be beneficial in expected cases of difficult epidural anaesthesia. Methods: We used digital ultrasound equipment with a 5-MHz transducer to assess the anatomy of the ES and the posterior parts of the spinal column. We examined 72 parturients with abnormal anatomical conditions who were scheduled for epidural anaesthesia. The women were randomised into two equal groups. In all patients, the standard loss of resistance technique was used. In the ultrasound group, an ultrasound examination of the appropriate spinal region was conducted prior to epidural puncture. ES depth seen on the ultrasound images was compared to the ES depth measured by the needle. We compared the number of puncture attempts with the standard method (control group) to the number of attempts under ultrasound guidance. Results: Ultrasonography significantly improved operating conditions for epidural anaesthesia. The maximum VAS scores and patient acceptance were significantly better. Conclusions: With ultrasound measurement of the ES depth, the quality of epidural anaesthesia was enhanced. [source]

(231) Use of Transmucosal Fentanyl in Non-Malignant, Chronic Pain

PAIN MEDICINE, Issue 3 2001
Forest Tennant
Transmucosal fentanyl (TF) has recently become available for treatment of breakthrough pain in cancer patients who are already tolerant to opioids. In addition to cancer patients, there is a growing number of chronic pain patients who regularly use and are tolerant to opioids and require a breakthrough opioid for adequate pain control. This pilot study was done to determine if TF is effective and acceptable to non-malignant, chronic pain patients who are opioid tolerant and require a breakthrough opioid(s) for pain control. Sixty patients with chronic, non-malignant pain who were maintained on a long-acting opioid and who required breakthrough pain control were given TF in an initial dose of 400 or 600 mcg per single, transmuscosal administration. Among the study group 35 (58.3%) experienced chronic pain due to injuries to the spine and 25 (41.7%) were due to medical conditions other than cancer. After at least three months of usage, patients were asked if they desired to continue TF and the reason(s) why they believed it to be effective. Fifty-eight (96.7%) of these subjects perceived that TF was an effective breakthrough opioid and desired to continue it. The single, effective dosage ranged from 800 to 1600 mcg per administration, and the number of separate monthly dosages ranged from 2 to 360. The majority of patients used TF only for emergency, pain purposes but others preferred TF as their major breakthrough opioid and ceased use of other short-acting opioids including injectable meperidine. Reported reasons for widespread patient acceptance included TF's fast action, fewer bed-bound days, increased energy, decreased use of other opioids, less depression, and fewer emergency room visits. This pilot study indicates that TF is effective and desired as a preferential opioid for breakthrough pain by a high percentage of chronic, non-malignant pain patients. [source]

DIADEM: implementation of a comprehensive disease management programme for type 2 diabetes

Effectiveness of Increasing Emergency Department Patients' Self-perceived Risk for Being Human Immunodeficiency Virus (HIV) Infected Through Audio Computer Self-interview,based Feedback About Reported HIV Risk Behaviors

ACADEMIC EMERGENCY MEDICINE, Issue 11 2009
Roland C. Merchant MD
Abstract Objectives:, Prior research has demonstrated that emergency department (ED) patient acceptance of human immunodeficiency virus (HIV) screening is partially dependent on patients' self-perceived risk of infection. The primary objective of this study was to determine the effectiveness of audio computer-assisted self-interview (ACASI)-based feedback. The intervention aimed to increase patient's self-perceived risk of being HIV infected by providing immediate feedback on their risk behaviors. Methods:, This 1-year, randomized, controlled trial at a U.S. ED enrolled a random sample of 18- to 64-year-old subcritically ill or injured adult patients who were not known to be HIV infected. All participants completed an anonymous, ACASI-based questionnaire about their HIV risk behaviors related to injection drug use and sex, as well as their self-perceived risk for being HIV infected. Participants were randomly assigned to one of two study groups: an intervention group in which participants received immediate ACASI-based feedback in response to each of their reported risk behaviors or a no-intervention group without feedback. Participants were asked to indicate their level of HIV risk on a five-point scale before and after they answered the questions. Change in level of self-perceived HIV risk was calculated and compared by study group using Pearson's chi-square test. An HIV risk behavior score that summarized reported HIV risk behavior was devised. Because HIV risk behaviors differ by sex, scores were calculated separately for each sex. Linear regression models that adjusted for study group and same subject covariance were employed to determine if higher HIV risk behavior scores were associated with an increase in self-perceived HIV risk. Results:, Of the 566 trial participants, the median age was 29 years (interquartile range [IQR] = 22,43 years), 62.2% were females, and 66.9% had been tested previously for HIV. After answering the reported HIV risk behavior questions, 12.6% of participants had an increase, 79.9% had no change, and 7.5% had a decrease in self-perceived HIV risk. Of the 46.6% of participants who initially indicated that they were not at risk for HIV, 11.4% had an increase in self-perceived HIV risk after answering the reported HIV risk behavior questions. Change in self-perceived HIV risk did not differ by study group (p = 0.77). There were no differences in reported HIV risk scores between the intervention and no-intervention groups for females (p = 0.78) or males (p = 0.86). In the linear regression models, a greater increase in self-perceived HIV risk was associated with higher reported HIV risk behavior scores for females (, = 0.59, 95% confidence interval [CI] = 0.15, 1.04) but not for males (, = 1.00, 95% CI = ,0.13 to 2.14). Conclusions:, Some ED patients can be moved, although modestly, to recognize their risk for being HIV infected by asking about their HIV risk behaviors. However, ACASI-based feedback messages about HIV risk behaviors do not increase subjects' self-perceived HIV risk. Female ED patients appear to increase their self-perceived HIV risk more than males when queried about their HIV risk behaviors. [source]

A Preliminary Report of Knowledge Translation: Lessons From Taking Screening and Brief Intervention Techniques From the Research Setting Into Regional Systems of Care

ACADEMIC EMERGENCY MEDICINE, Issue 11 2009
Edward Bernstein MD
Abstract This article describes a limited statewide dissemination of an evidence-based technology, screening, brief intervention, and referral to treatment (SBIRT), and evaluation of the effects on emergency department (ED) systems of care, utilizing the knowledge translation framework of reach, effectiveness, adoption, implementation, and maintenance (RE-AIM), using both quantitative and qualitative data sources. Screening and brief intervention (SBI) can detect high-risk and dependent alcohol and drug use in the medical setting, provide early intervention, facilitate access to specialty treatment when appropriate, and improve quality of care. Several meta-analyses demonstrate its effectiveness in primary care, and the federal government has developed a well-funded campaign to promote physician training and adoption of SBI. In the busy environment of the ED, with its competing priorities, researchers have tested a collaborative approach that relies on peer educators, with substance abuse treatment experience and broad community contact, as physician extenders. The ED-SBIRT model of care reflects clinician staff time constraints and resource limitations and is designed for the high rates of prevalence and increased acuity typical of ED patients. This report tracks services provided during dissemination of the ED-SBIRT extender model to seven EDs across a northeastern state, in urban, suburban, and rural community settings. Twelve health promotion advocates (HPAs) were hired, trained, and integrated into seven ED teams. Over an 18-month start-up period, HPAs screened 15,383 patients; of those, 4,899 were positive for high risk or dependent drinking and/or drug use. Among the positive screens, 4,035 (82%) received a brief intervention, and 57% of all positives were referred to the substance abuse treatment system and other community resources. Standardized, confidential interviews were conducted by two interviewers external to the program with 24 informants, including HPAs and their supervisors, clinicians, nurse managers, and ED directors across five sites. A detailed semistructured format was followed, and results were coded for thematic material. Barriers, challenges, and successes are described in the respondents' own words to convey their experience of this demonstration of SBIRT knowledge translation. Five of seven sites were sustained through the second year of the program, despite cutbacks in state funding. The dissemination process provided a number of important lessons for a large rollout. Successful implementation of the ED-SBIRT HPA model depends on 1) external funding for start-up; 2) local ED staff acting as champions to support the HPA role, resolve territorial issues, and promote a cultural shift in the ED treatment of drug and alcohol misuse from "treat and street" to prevention, based on a knowledge of the science of addiction; 3) sustainability planning from the beginning involving administrators, the billing and information technology departments, medical records coders, community service providers, and government agencies; and 4) creation and maintenance of a robust referral network to facilitate patient acceptance and access to substance abuse services. [source]

Bilateral ankle blocks: A prospective audit

ANZ JOURNAL OF SURGERY, Issue 1-2 2005
Glenda E Rudkin
Background: There are significant advantages to the practice of bilateral ankle block. However, clinicians are reluctant to employ this technique due to concerns over reliability, local anaesthetic longevity and toxicity, surgical efficiency, and patient comfort. Methods: Sixty-six patients undergoing bilateral ankle blocks during mid- and forefoot surgery were audited to determine success rate, local anaesthetic safety and efficacy, and patient acceptance. Intravenous sedation was administered both during insertion of ankle blocks and intraoperatively, as requested by the patient and as deemed necessary by the anaesthetist. The choice of local anaesthesia was either a 50/50 mixture of lignocaine 1.5% plain and ropivacaine 7.5 mg/mL, ropivacaine 7.5 mg/mL alone or ropivacaine 7.5 mg/mL and clonidine 1 µg/kg. Results: A total of 89% of patients had a successful bilateral ankle block. Ropivacaine and clonidine combination, ropivacaine, and ropivacaine and lignocaine combination provided a mean length of action of 17 h, 14 h and 8 h, respectively. No adverse local anaesthetic events were reported. Sixty-one per cent of patients remembered intraoperative events; only one patient would choose not to have the procedure performed again under ankle blocks. Conclusions: The present audit demonstrates that bilateral ankle blocks are a safe and efficient technique. With appropriate doses of sedative drugs both during insertion of the ankle block and surgery, patients remain comfortable. [source]

Improved patient acceptability with a transdermal drug-in-adhesive oestradiol patch

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2000
Yvonne Lake
SUMMARY The aim of this trial was to assess the relative patient acceptability of two transdermal oestradiol patches used in treatment of oestrogen deficiency in postmenopausal women. Thirty-five hysterectomised postmenopausal women with no previous experience of transdermal oestradiol delivery systems received treatment with either once-weekly drug-in-adhesive (DIA) patches or twice-weekly reservoir patches for 4 weeks, and were then switched to the alternative treatment for a further 4 weeks. At the end of the study, the patients completed a questionnaire to assess their relative preference for a number of characteristics of the 2 transdermal systems and, where possible, their preference for transdermal compared with oral hormone replacement therapy. Thirty-one patients completed the study; four withdrew during treatment with the reservoir patch. The DIA patch was preferred for being ,easiest to remember to apply' by 80% of patients (p < 0.01), ,easiest to open' and ,easiest to apply' by 68% (p = 0.025), and as having ,best cosmetic appearance' by 65% (p = 0.05) and ,best overall skin adhesion' by 61% (p < 0.01). While 10% of patients rated the reservoir patch as ,least irritating to the skin' (p = 0.03), only one patient found this patch ,most comfortable to wear' (p < 0.01). The DIA patch was selected by 87% of patients as their preferred treatment overall (p = 0.001). Ninety-one per cent of 22 responding patients were at least as confident of treatment with transdermal patches as with oral hormone replacement therapy (p = 0.006) and 74% of 27 responders preferred transdermal to oral treatment (p = 0.004). The DIA patch appears to be more acceptable to patients than the reservoir patch as a transdermal oestradiol delivery system for the treatment of postmenopausal oestrogen deficiency. Characteristics of the DIA patch which may account for improved patient acceptance include ease of remembering once-weekly patch application, improved cosmetic appearance and comfort, and better adhesion. [source]

Burning mouth syndrome and psychological disorders

AUSTRALIAN DENTAL JOURNAL, Issue 2 2009
LM Abetz
Abstract Burning mouth syndrome (BMS) is an oral dysaesthesia that causes chronic orofacial pain in the absence of a detectable organic cause. The aetiology of BMS is complex and multifactorial, and has been associated in the literature with menopause, trigger events and even genetic polymorphisms. Other studies have found evidence for mechanisms such as central and peripheral nervous system changes, with clinical and laboratory investigations supporting a neuropathologic cause. These physiological explanations notwithstanding, there is still much evidence that BMS aetiology has at least some psychological elements. Somatoform pain disorder has been suggested as a mechanism and factors such as personality, stress, anxiety, depression and other psychological, psychosocial and even psychiatric disorders play a demonstrable role in BMS aetiology and symptomatology. In order to treat BMS patients, both physiological and psychological factors must be managed, but patient acceptance of possible components of psychological disease basis is a major hurdle. Clinical signs of patient stress, anxiety or depression are a useful reinforcement of clinical discussions. The current paper proposes a number of clinical signs that may be useful for both clinical assessment and subsequent patient discussions by providing visible supportive evidence of the diagnosis. [source]

Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy

Older age predicts a decline in adjuvant chemotherapy recommendations for patients with breast carcinoma

CANCER, Issue 9 2003
Evidence from a tertiary care cohort of chemotherapy-eligible patients
Abstract BACKGROUND The appropriate use of adjuvant chemotherapy for elderly women with breast carcinoma remains controversial. Efficacy data in women age , 70 years are scarce, resulting in a lack of clear guidelines for patients in this age group. Although several studies have demonstrated decreasing use of chemotherapy with age, none specifically examined its use in an elderly cohort of patients who were deemed eligible for such therapy based on consensus guidelines, simultaneously examining the impact of comorbidity and previous history of malignant disease on these recommendations. METHODS The authors examined adjuvant chemotherapy use among chemotherapy-eligible patients age , 50 years who were evaluated in a tertiary care cancer center. Associations between patient age and 1) physician recommendation for adjuvant chemotherapy, 2) recommended treatment regimen, and 3) patient acceptance of the treatment plan recommended were examined, adjusting for the impact of aggressive tumor characteristics, medical comorbidity, previous history of malignant disease, and features of the treatment setting. RESULTS Of the 208 chemotherapy-eligible patients who were studied, 74% overall were recommended chemotherapy. Chemotherapy was recommended to 92% of women age 50,59 years compared with 77% of women age 60,69 years and 23% of women age , 70 years. Increasing age was associated strongly with a decreasing likelihood of receiving a recommendation in favor of chemotherapy. After adjusting for estrogen receptor status, previous history of malignant disease, comorbidity score, and prognostic group, the odds of receiving a recommendation in favor of chemotherapy fell by 22% per year or 91% per 10-year interval, and the rate of decline did not change significantly at age , 70 years. We found no age-related differences in either the drug regimens recommended or patient acceptance rates for adjuvant therapy. CONCLUSIONS Age was associated strongly and independently with physician recommendation for adjuvant chemotherapy among a group of older women who were eligible specifically for such therapy. Medical comorbidity and a history of previous malignant disease did not alter this correlation significantly, although the latter was a significant predictor of chemotherapy use. Further studies clearly are needed to determine the underlying reasons for this strong age effect and to explore strategies that will optimize the utilization of this potentially curative therapy in the elderly. Cancer 2003;97:2150,9. © 2003 American Cancer Society. DOI 10.1002/cncr.11338 [source]

The Marius Implant Bridge: Surgical and Prosthetic Rehabilitation for the Completely Edentulous Upper Jaw with Moderate to Severe Resorption: A 5-Year Retrospective Clinical Study

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2002
Yvan Fortin DDS
ABSTRACT Background: Patients seeking replacement of their upper denture with an implant-supported restoration are most interested in a fixed restoration. Accompanying the loss of supporting alveolar structure due to resorption is the necessity for lip support, often provided by a denture flange. Attempts to provide a fixed restoration can result in compromises to oral hygiene based on designs with ridge laps. An alternative has been an overdenture prosthesis, which provides lip support but has extensions on to the palate and considerations of patient acceptance. The Marius bridge was developed as a fixed bridge alternative offering lip support that is removable by the patient for hygiene purposes, with no palatal extension beyond normal crown-alveolar contours. Purpose: Implant-supported restorative treatment of completely edentulous upper jaws, as an alternative to a complete denture, is frequently an elective preference, and it requires significant patient acceptance beyond the functional improvement of chewing. Patients with moderate to severe bone resorption and thin ridges present additional challenges for adequate bone volume and soft-tissue contours. The purpose of this investigation was to develop a surgical and prosthetic implant treatment protocol for completely edentulous maxillae in which optimal lip support and phonetics is achieved in combination with substantial implant anchorage without bone grafting. Materials and Methods: The Marius bridge is a complete-arch, double-structure prosthesis for maxillae that is removable by the patient for oral hygiene. The first 45 consecutive patients treated by one person (YF) in one center with this concept are reported, with 245 implants followed for up to 5 years after prostheses connection. Results: The cumulative fixture survival rate for this 5-year retrospective clinical study was 97%. Five fixtures failed before loading, in five different patients, and two fixtures in the same patient failed at the 3-year follow-up visit. None of the bridges failed, giving a prostheses survival rate of 100%. The complications were few and mainly prosthetic: nine incidences of attachment component complications, one mesobar fracture, and three reports of gingivitis. All complications were solved or repaired immediately, with minimal or no interruption of prostheses use. Conclusions: Satisfactory medium-term results of survival and patient satisfaction show that the Marius bridge can be recommended for implant dentistry. The technique may reduce the need for grafting, because it allows for longer implants to be placed with improved bone anchorage and prostheses support. [source]