Can dermal thickness measured by ultrasound biomicroscopy assist in determining osteoporosis risk?

BACKGROUND AND PURPOSE

A study was undertaken to evaluate the relationship between dermal thickness and bone density. Ninety-eight female subjects were recruited from a population of patients attending a university hospital osteoporosis clinic. The subject population ranged in age from 30 to 88 years with a mean age of 60. The weight range was from 91 to 274 pounds, mean 142 pounds.

METHODS

Dermal thickness measurements were taken at the right forearm using a Longport high resolution 20 MHz ultrasound scanner. Bone density measurements were taken using a GE Lunar Prodigy DXA scanner at both hips.

RESULTS

Statistical analysis using the intraclass correlation coefficient (ICC) of the skin measurements showed that the dermal measurement technique was highly reliable (CI=0.87, 0.92). Linear regression was used to examine the value of dermal thickness as a predictor of bone density. The correlation coefficient between dermal thickness and hip T score was statistically significant in the positive direction (corr.=0.304, P=0.001). We further investigated the relationship between dermal thickness and T scores using penalized splines.

CONCLUSION

This analysis indicated that the strongest association with bone density occurred between 1.0 and 1.5 mm of dermal thickness. In those subjects identified as having osteoporosis dermal thickness measure of > or =1.04 corresponds to 4% of the subjects having osteoporosis. If dermal thickness is <1.04 then 23% have osteoporosis.

Summarizing benchmarks in the national database of nursing quality indicators using bootstrap confidence intervals

When summarizing the benchmarks for nursing quality indicators with confidence intervals around the means, bounds too high or too low are sometimes found due to small sample size or violation of the normality assumption. Transforming the data or truncating the confidence intervals at realistic values can solve the problem of out of range values. However, truncation does not improve upon the non-normality of the data, and transformations are not always successful in normalizing the data. The percentile bootstrap has the advantage of providing realistic bounds while not relying upon the assumption of normality and may provide a convenient way of obtaining appropriate confidence intervals around the mean for nursing quality indicators.

Reliability Testing of the National Database of Nursing Quality Indicators Pressure Ulcer Indicator

A criterion-referenced Web-based test was designed and administered to 256 individuals at 48 randomly sampled National Database of Nursing Quality Indicators (NDNQI) member hospitals to determine the reliability of the NDNQI pressure ulcer indicator. Overall kappa values for pressure ulcer identification, staging, and sourcing indicate moderate to near perfect reliability. Findings suggest that nurses can accurately differentiate pressure ulcers from other ulcerous wounds in Web-based photographs, reliably stage pressure ulcers, and reliably identify community versus nosocomial pressure ulcers.

Inflammatory mediators and immune function are altered in home parenteral nutrition patients

OBJECTIVES

Patients who used home parenteral nutrition (HPN) and healthy, volunteer control subjects were examined to assess relative immune potential and inflammatory marker expression and to investigate the association between HPN and immune parameters.

METHODS

Subjective Global Assessments were performed on all subjects. The peripheral blood concentration of C-reactive protein was determined by enzyme-linked immunosorbent assay. The peripheral blood concentration of systemic inflammatory mediators that included tumor necrosis factor-alpha (TNF-alpha), soluble TNF-alpha receptors p55 and p75, and interleukin-6 were similarly determined. Peripheral blood lymphocytes were isolated and the percentage of circulating CD4+ and CD8+ lymphocytes was determined by flow cytometry. In addition, peripheral blood lymphocytes were cultured in the presence of the T-cell mitogen, phytohemagglutinin, and the proliferative response of the CD3+ population was assessed by flow cytometry. Results of these experiments were obtained for 10 clinically stable patients who had used HPN longer than 2 y and these results were compared by Student's t test with data obtained for 12 normal, volunteer control subjects.

RESULTS

Of the 10 patients who used HPN and were examined, seven had short bowel syndrome, two had dysmotility, and one required HPN due to radiation enteritis. Based on Subjective Global Assessments, all patients were well nourished. No difference was observed in TNF-alpha level between groups and C-reactive protein levels were within normal limits (1.2 mg/L in patients, 0.99 mg/L in controls). Soluble TNF-alpha receptors p55 and p75 were significantly increased (P < 0.001), but serum interleukin-6 was not (P = 0.07). The percentage of CD8+ cells and the CD4+/CD8+ ratio were not statistically different between groups. In contrast to this result, the percentage of CD4+ cells and the proliferative T-cell response to phytohemagglutinin were significantly depressed in patients who used HPN versus control subjects.

CONCLUSIONS

These data suggest the presence of an underlying inflammatory process and subsequent abnormal T-lymphocyte function in patients who use HPN.

Smoking cessation strategy use among pregnant ex-smokers

There is strong evidence for the beneficial health effects associated with smoking cessation during pregnancy. Although many pregnant women spontaneously quit smoking during pregnancy, postpartum relapse is high. Evidence suggests that pregnant women do not use smoking cessation strategies as identified by the 40-item Processes of Change Scale as frequently as others who quit smoking. The purpose of this study is to identify factors associated with pregnant exsmokers' use of experiential and behavioral smoking cessation strategies. A cross-sectional survey design is used for the study. From a sample of 201 primarily low-income pregnant women recruited to participate in a larger study, 58 were biologically confirmed ex-smokers. Multiple regression analysis reveals that motivation to quit smoking is the only significant factor explaining the use of experiential and behavioral smoking cessation strategies, accounting for 44% of the variance in experiential processes and 31% of the variance in behavioral processes.

Opening plugged tympanostomy tubes

OBJECTIVE

To determine the most effective solvents for dissolving plugged tympanostomy tubes.

STUDY DESIGN

In vitro laboratory study.

METHODS

Twelve solvents (including ototopical antibiotics and water) were applied to fluoroplastic tympanostomy tubes (n = 260) plugged with dried mucoid middle ear effusion in an ear canal-tympanic membrane model. Time to clearance of the tympanostomy tubes was both visually and tympanometrically determined.

RESULTS

Vinegar (P =.0030) and hyaluronidase solutions (P =.0030) were significantly better solvents than water.

CONCLUSION

Vinegar and hyaluronidase solutions are more likely to clear plugged tympanostomy tubes than water and ototopical antibiotics, but vinegar is the preferred solution because of its known relative safety for use in the ear.