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Comparative analysis of paediatric and adult surgically drained dental infections at a university teaching hospital. Br J Oral Maxillofac Surg 2020; 58:e307-e311. [PMID: 33011021 DOI: 10.1016/j.bjoms.2020.08.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/11/2020] [Indexed: 12/20/2022]
Abstract
In the United Kingdom (UK) the estimated prevalence of dental infection involving the supporting bone is 2%, and from 2014-2015 there were 2281 admissions in England alone due to dental abscess. We undertook an analysis of 184 dental abscesses that required surgical drainage, as there is surprisingly little in the literature on the subject. This was a retrospective study of 184 consecutive patients with dental abscesses who were admitted between January 2016 and September 2019. On admission, all patients had orthopantomograms (OPG) and baseline blood tests. Surgical drainage was performed under a general or local anaesthetic and a pus swab sent for culture and sensitivity. The submandibular space was the most commonly involved site and paediatric patients most often presented with buccal space abscesses. A lower molar tooth was the cause in 132 patients. White blood cells (WBC) and C-reactive protein (CRP) were both raised in 63.6% (n=117), but were normal in 4.9% (n=9). The remaining patients had either raised WBC (2.7%) or CRP (28.8%). Streptococcus milleri was the most common organism isolated in 66.6% (n=42). There was no association between CRP or WBC values and duration of hospital stay. Paediatric patients had a shorter duration of admission (1.96 days vs 2.81 days) and significantly lower CRP values (120.9 vs 45.7; p=0.001). The submandibular space was the commonest site involved and mandibular molars the most frequent source of infection. An elevated CRP value appeared to be a more sensitive indicator of infection in this study population. Adult and paediatric patients present in a different manner.
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A Faculty Development Workshop for High-Value Care Education Across Clinical Settings. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10745. [PMID: 30800945 PMCID: PMC6346274 DOI: 10.15766/mep_2374-8265.10745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/28/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Despite rising health care costs, trainees frequently do not receive formal high-value care (HVC) training. As medical education often occurs through informal learning, it is imperative that medical educators be prepared to teach HVC concepts across clinical settings. METHODS This workshop was created to provide frameworks for teaching HVC across four pediatric educational settings: (1) case-based conferences, (2) inpatient rounding, (3) ambulatory visits, and (4) conversations with patients and families. Frameworks were developed based on literature review, content experts' knowledge, and internal assessment and feedback. The workshop was divided into two sections: a didactic overview of HVC education and interactive small-group sessions to practice application of the Toolkit for Teaching High-Value Care. At the end of the workshop, participants completed the Prescription for High-Value Care to create a personal action plan. RESULTS This workshop has been presented at both national and local pediatric conferences. From over 89 evaluations (83% response rate), participants felt the workshop met objectives, served as a valuable use of their time, and provided useful resources. Evaluations elicited specific actions that participants gleaned from workshop content along with proposed behavior changes, such as creating HVC case-based conferences at their home institution and initiating more value-based discussions. DISCUSSION This workshop has been successfully presented in both national and local settings and has been well received by participants. The workshop is targeted for clinical educators and aims to address the gap in faculty development for HVC education.
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Improvement measures for complete excision of the malignant tongue tumour: retrospective factor analysis of 101 consecutive cases. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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R-SCAN: Imaging for Pediatric Minor Head Trauma. J Am Coll Radiol 2017; 14:294-297. [DOI: 10.1016/j.jacr.2016.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 10/06/2016] [Accepted: 10/07/2016] [Indexed: 10/20/2022]
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New NICE referral guidance for oral cancer: does it risk delay in diagnosis? Br J Oral Maxillofac Surg 2016; 55:404-406. [PMID: 27823849 DOI: 10.1016/j.bjoms.2016.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022]
Abstract
Changes to guidance about the two-week wait referrals for suspected cancer of the head and neck have created a new recommendation for a general medical practitioner to refer any patients to a dentist under certain criteria. The potential effect of this was assessed based on 91 referrals to an oral and maxillofacial unit. A total of 33 met the criteria for initial referral to a dentist; of these, one was later diagnosed with cancer. We outline the potential deleterious effects the new guidance might have on the rapid diagnosis of oral lesions.
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Conservative management of high output chyle leak in difficult to manage cases. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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A perspective on the role of the pectoralis major flap in oral and maxillofacial oncology surgery. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/ors.12080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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A failure-proof surgical technique for marginal resections and angulated osteotomies? Br J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.bjoms.2013.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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A standardized method with CBCT/DVT for porous implant follow-up. A two phase human study with hydroxyapatit (HA) and aluminium-oxide ceramic porous implants. Br J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.bjoms.2012.04.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Comparison of temporomandibular joint dysfunction following wisdom tooth extraction under general anaesthesia (GA) to local anaesthesia (LA). Br J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.bjoms.2012.04.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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An assessment of the stability of differing types of fixation following segmental resection of the mandible. Br J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.bjoms.2012.04.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Biomechanical study of the effectiveness of unilocking T-plate systems for prophylactic internal fixation of the radial osteocutaneous donor site. Br J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.bjoms.2011.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Trends in presentations at the British Association of Oral and Maxillofacial Surgery Annual Scientific Meetings. Br J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.bjoms.2011.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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P103 Temporomandibular joint dysfunction following third molar surgery under general anaesthesia – retrospective audit. Br J Oral Maxillofac Surg 2010. [DOI: 10.1016/s0266-4356(10)60192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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New patient or established patient? The answer is not always obvious. TENNESSEE MEDICINE : JOURNAL OF THE TENNESSEE MEDICAL ASSOCIATION 2010; 103:32. [PMID: 20481245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Ultrasound assessment of bony healing in the management of mandibular non-union. Int J Oral Maxillofac Surg 2009. [DOI: 10.1016/j.ijom.2009.03.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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A 10-year review of the indications for the pedicled pectoralis major flap in modern maxillofacial reconstructive surgery. Int J Oral Maxillofac Surg 2009. [DOI: 10.1016/j.ijom.2009.03.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Defining the role of percutaneous endoscopic gastrostomy in head and neck oncology practice. Int J Oral Maxillofac Surg 2009. [DOI: 10.1016/j.ijom.2009.03.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The changing pattern of infection with MRSA and other organisms with major maxillofacial flap surgery. Br J Oral Maxillofac Surg 2008. [DOI: 10.1016/j.bjoms.2008.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The prospective experience of a maxillofacial surgeon with the percutaneous endoscopic gastrostomy technique. Int J Oral Maxillofac Surg 2008; 37:140-8. [DOI: 10.1016/j.ijom.2007.08.465] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 06/18/2007] [Accepted: 08/31/2007] [Indexed: 10/22/2022]
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Partial avulsion of the inferior rectus: An unusual cause of diplopia after blunt orbital trauma. Br J Oral Maxillofac Surg 2007; 45:240-1. [PMID: 16263197 DOI: 10.1016/j.bjoms.2005.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Accepted: 08/10/2005] [Indexed: 11/30/2022]
Abstract
A 14-year-old boy had a severe blow to the right orbit, which caused a blow-out fracture of the orbital floor and damage to the inferior rectus with resultant diplopia. After two operations his vision is still not perfect.
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Re: “Localized Inferior Orbital Fibrosis Associated With Porcine Dermal Collagen Xenograft Orbital Floor Implant”. Ophthalmic Plast Reconstr Surg 2005; 21:249; author reply 249-51. [PMID: 15942510 DOI: 10.1097/01.iop.0000162957.54463.9e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A standardised preprinted template for recording of maxillofacial oncological operations. Br J Oral Maxillofac Surg 2004; 42:342-7. [PMID: 15225955 DOI: 10.1016/j.bjoms.2004.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2004] [Indexed: 11/15/2022]
Abstract
Completion of accurate and legible operating notes are the clinician's responsibility. They require time, precision, concentration and legibility. A preprinted template helps meet these needs and complies with the guidelines of the Royal College of Surgeons.
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A Restoration Success: Longleaf Pine Seedlings Established in a Fire-Suppressed, Old-Growth Stand. ECOL RESTOR 2004. [DOI: 10.3368/er.22.1.6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Re: Godden D R P, Thomas S J. Survival of a free flap after vascular disconnection at 9 days. Br J Oral Maxillofac Surg 2002; 40: 446-447. Br J Oral Maxillofac Surg 2003; 41:281. [PMID: 12946680 DOI: 10.1016/s0266-4356(03)00063-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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What have you been told about your illness? Information about diagnosis among psychiatric inpatients. Int J Psychiatry Clin Pract 2002; 6:103-6. [PMID: 24931936 DOI: 10.1080/136515002753724108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION In current psychiatric practice clinicians tend to share with patients information regarding their illness. However, little is known about what the patients would in fact like to know about their diagnosis and prognosis. METHOD We have conducted a cross-sectional survey among psychiatric inpatients, to explore what they believe is wrong with them, what they have been told and by whom, and what they wish to know about their illness. RESULTS The results have shown that 80% of the patients received some information about their illness and 37% of the participants had satisfactory insight. However only 46% of the participants declared that they wished to know what was wrong with them. CONCLUSIONS We conclude that although many patients would like to know the truth, the rights of those who do not wish to know should also be respected. Therefore the diagnosis of mental disorder should not be routinely disclosed, but mental health professionals should take into consideration their patients' preferences and act appropriately to their choice. (Int J Psych Clin Pract 2002; 6: 103-106).
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Inpatient insulin initiation using a hospital in the home unit. Intern Med J 2001; 31:492-4. [PMID: 11720064 DOI: 10.1046/j.1445-5994.2001.00106.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Between 1997 and 1999, more than 300 patients have been treated using negative pressure wound dressings. The technique has been used successfully to prepare various acute, chronic or infected wounds to accept a skin graft or flap, and to promote graft take at difficult donor sites. The advantages include rapid healing by secondary intention, reduced time to skin grafting, an increase in the rate of graft take and a reduction in donor site complications. The dressing can be applied quickly and easily and there have been no serious complications.
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Negative pressure wound dressing of the radial forearm donor site. Int J Oral Maxillofac Surg 2000; 29:198-200. [PMID: 10970082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Donor site complications of the radial forearm are a significant cause of post-operative morbidity. 15 patients had radial forearm free tissue donor sites treated with split skin grafts and a negative pressure dressing. All grafts showed 100% take at 5 days. The advantages of this technique include rapid healing at an unfavourable graft recipient site, increased graft take and decreased donor site complications. This method is ideally suited for the management of large defects. The dressing can be quickly and easily applied and there have been no significant complications.
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Diabetes education materials: recommendations of tribal leaders, Indian health professionals, and American Indian community members. DIABETES EDUCATOR 2000; 26:290-4. [PMID: 10865594 DOI: 10.1177/014572170002600209] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The Association of American Indian Physicians, the only national organization of its kind, conducted a series of focus groups to gather input from tribal leaders, Indian health professionals, and American Indian community members to guide the development of culturally appropriate diabetes education materials for the National Diabetes Education Program. METHODS During the focus groups, participants shared their experiences with and recommendations for a variety of diabetes education materials. RESULTS Overall, 95% of participants expressed a strong preference for diabetes education materials relevant to their specific tribe or culture. CONCLUSIONS Recommendations from these focus groups were used to develop a national diabetes education campaign for American Indian communities.
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Abstract
We carried out a retrospective study of fracture morbidity of radial forearm osteocutaneous donor sites. During a period of three-and-a-half years, 12 patients had had composite flaps taken, and 5 of them had subsequently fractured the radius. We then elected to plate the radius prophylactically and found that over a period of just over two years, none of the 8 patients who had had prophylactic plating at the original harvesting operation had subsequently fractured the radius.
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A retrospective analysis of 182 salivary gland tumours. Br J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0266-4356(97)90628-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Valsartan, a new angiotensin II receptor antagonist: a double-blind study comparing the incidence of cough with lisinopril and hydrochlorothiazide. J Clin Pharmacol 1997; 37:101-7. [PMID: 9055135 DOI: 10.1002/j.1552-4604.1997.tb04767.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The present study compares the occurrence of a dry, persistent cough with doses of 80 mg of valsartan, 10 mg of lisinopril, or 25 mg of hydrochlorothiazide in patients with a history of angiotensin-converting enzyme inhibitor-induced cough. This was a randomized, double-blind, active-controlled, parallel group, multicenter trial involving 129 adult outpatients with essential hypertension. After confirmation of angiotensin-converting enzyme inhibitor-induced cough during a 2 to 4 week challenge with lisinopril (followed by a washout period of 2 weeks), patients were randomized to receive 6 weeks of double-blind treatment once daily with 80 mg valsartan, 10 mg lisinopril, or 25 mg hydrochlorothiazide. Assessments were made at baseline and after 3 and 6 weeks of treatment. Comparability of response to treatment was assessed by mean sitting diastolic and systolic blood pressure at the end of treatment. The occurrence of a dry, persistent cough was significantly less (P < 0.001) at 3 and 6 weeks with valsartan (19.5%) than with lisinopril (68.9%), with no significant difference between valsartan and hydrochlorothiazide (19.0%). There were no statistically significant differences in reduction of blood pressure among the three treatment groups. The overall incidence of adverse experiences, whether or not treatment-related, was highest for lisinopril (86.7%) compared with valsartan (57.1%), and hydrochlorothiazide (61.9%). A dry cough in the lisinopril group accounted for this difference. There were no clinically significant changes in physical signs or in results of clinical laboratory evaluations during double-blind treatment, except for from metabolic changes in 3 patients receiving hydrochlorothiazide. In hypertensive patients with a history of angiotensin-converting enzyme inhibitor-induced cough, a single daily dose of 80 mg of valsartan produced therapeutic efficacy comparable to lisinopril but with significantly less cough.
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The need for longitudinal research. Nurse Pract 1996; 21:6. [PMID: 8720185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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A misplaced molar. Br Dent J 1995; 178:362. [PMID: 7779492 DOI: 10.1038/sj.bdj.4808765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Risks to selves, risks to others. THE AMERICAN ECONOMIC REVIEW 1995; 85:61-66. [PMID: 10160513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Infectious mononucleosis presenting as a parotid mass with associated facial nerve palsy. Int J Oral Maxillofac Surg 1991; 20:193-5. [PMID: 1940493 DOI: 10.1016/s0901-5027(05)80171-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A case of infectious mononucleosis presenting as parotid lymphadenopathy and associated partial facial nerve palsy is described and the possible diagnostic confusion with a malignant neoplasm emphasised. Infectious mononucleosis and other viral diseases which caused facial nerve palsy are discussed and the literature reviewed.
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Biological and neuropsychological characterization of physostigmine responders and nonresponders in Alzheimer's disease. J Am Geriatr Soc 1990; 38:113-22. [PMID: 2405043 DOI: 10.1111/j.1532-5415.1990.tb03471.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To assess the efficacy of oral physostigmine for the treatment of Alzheimer's disease, 20 patients were entered into a clinical trial. All patients underwent a dose-finding phase (two weeks), followed by an open trial (two weeks), and a double-blind crossover phase (two weeks drug, two weeks placebo). Extensive neuropsychological testing (Buschke Selective Reminding procedure, category generation, picture recognition, finger tapping) and measurement of systemic cholinergic parameters were measured during each of these phases. Patients were classified as physostigmine responders and nonresponders based on a priori established criteria. Using these, nine patients were found to respond to physostigmine, while 11 were classified as nonresponders. During baseline conditions, responders when compared to nonresponders were found to have higher concentrations of red blood cell (RBC) choline (Ch) and higher ratios of RBC Ch to plasma Ch. Neuropsychological tests were found to fall into one of three categories. The first group of tests were sensitive to drug effects and differentiated physostigmine responders from nonresponders; the second group was found to predict responsiveness; and the third group was neither predictive nor sensitive to drug effects.
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Abstract
Otorrhea is the most frequent complication of the use of tympanostomy tubes. When it occurs after the immediate postoperative period, otorrhea is probably the result of external contamination of the middle ear or acute otitis media. We analyzed data from 627 operations upon 1248 ears of 491 children with chronic secretory otitis media and found that delayed onset (longer than 7 weeks) postoperative otorrhea occurred after 26.4 percent of the 382 operations in which tympanostomy tubes were used. The average number of episodes of otorrhea per case was 1.46 and ranged from 1 to 9. The rate of otorrhea occurrence in patients with tubes in place was significantly higher in the summer months. Otorrhea also occurred after 9.0 percent of 245 myringotomy procedures. The average number of episodes was 1.32 and ranged from 1 to 3. Treatment of postoperative otorrhea increases the health care costs of surgical treatment of chronic otitis media with effusion; this problem should be included in the calculation of cost-effectiveness.
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Abstract
Referral of pregnancies complicated by suspected fetal anomalies to level III perinatal centres for further evaluation and management is increasing as use of real-time ultrasound spreads, but the sensitivity and specificity of the prenatal diagnoses made in this population are unknown. We undertook a prospective study that followed pregnancies referred to a designated programme dealing with suspected fetal abnormalities. Follow-up of 257 pregnancies revealed that 282 separate anomalies were accurately diagnosed in 212 cases. Normal anatomy was correctly predicted in 42 cases, 16 per cent of the referred population. False-positive and false-negative rates were 1.5 per cent (4/257) and 2 per cent (1/46), respectively. However, 37 per cent of those infants born with anomalies had additional problems not prenatally detected by ultrasound. These results indicate that prenatal ultrasound diagnoses are remarkably accurate overall but that they may be insensitive to associated anomalies in individual cases.
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The pneumostome rhythm in slugs: a response to dehydration controlled by hemolymph osmolality and peptide hormones. COMPARATIVE BIOCHEMISTRY AND PHYSIOLOGY. A, COMPARATIVE PHYSIOLOGY 1988; 89:579-85. [PMID: 2899479 DOI: 10.1016/0300-9629(88)90836-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
1. One response of the terrestrial slug, Limax maximus to dehydration is the initiation and modulation of the pneumostome rhythm. When a slug has lost 15-20% of its initial body weight by evaporation, the frequency of pheumostome closures, which is less than 0.5 closures/min in fully hydrated slugs, begins to increase. 2. The frequency increases with further dehydration, but the average duration of each closure remains constant. Thus, the proportion of time during which the pneumostome is closed increases. Simultaneously, the area of the pneumostome opening decreases. 3. This behavior appears to be controlled in part by both the osmolality of the slug's hemolymph and by a peptide closely related to arginine vasotocin (AVT) and arginine vasopressin (AVP). Injecting intact slugs with mannitol, which increases the osmolality of the hemolymph, or with AVT or AVP, can initiate the pneumostome rhythm. 4. Mannitol injections, however, do not provoke the decrease in the area of the pneumostome opening which is induced by natural dehydration or by AVT or AVP injection. This suggests that at least two systems may be involved in the overall control of the pneumostome.
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Abstract
Otorrhea is the most common complication of surgical drainage of the tympanum for the treatment of chronic secretory otitis media. Otorrhea present at the first postoperative visit may be due to the operative procedure, the underlying disease process, or both. After analyzing data from 525 operations on 1045 ears of 396 children with chronic secretory otitis media, and finding an over-all incidence of immediate postoperative otorrhea of 3.4%, we conclude that preparations of the ear canal with povidone iodine and the postoperative prophylactic use of an antimicrobial-corticosteroid topical preparation provides optimal control of postoperative wound infection. Sporadic increases in the incidence of postoperative otorrhea may be due to extrinsic factors such as outbreaks of upper respiratory infection.
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Abstract
The presence of middle ear effusion may be inferred from a tympanogram by the configuration of the pressure compliance curve. Not infrequently, however, effusion is absent at the time of surgery when strongly indicated by preoperative tympanometry. We evaluated this discrepancy by contrasting preoperative tympanograms with the findings at surgery in 462 children, aged 4 to 8 years, with clinical evidence of persistent effusion in 909 ears. Based on these results we can classify tympanograms as to high risk for effusion, intermediate, and low risk. The proportion of ears with effusion was 83%, 47%, and 34%, respectively. The proportion of ears with fluid in the high risk tympanogram group did not change appreciably over a 1- to 8-week period, ie, no trend toward spontaneous resolution occurred. The high incidence of effusion at surgery in our low risk group is far higher than expected and is presumably due to reinfection of these ears during the time between examination and operation.
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