Patient definitions of transplant success in upper extremity vascularized composite allotransplantation: A mixed-methods study

Objective

Upper extremity vascularized composite allotransplantation is an innovative treatment option for people with upper extremity amputations. Limited patient-relevant long-term outcomes data about transplant success may impede patients' informed treatment decision-making. We assessed perceptions of what constitutes upper extremity vascularized composite allotransplantation success among individuals with upper extremity amputations.

Methods

This multisite study entailed interviews and focus groups with individuals with upper extremity amputations and upper extremity vascularized composite allotransplantation candidates, participants, and recipients. We examined perceptions of transplant success and preferences for five upper extremity vascularized composite allotransplantation outcomes. Qualitative data were analyzed using thematic analysis; and quantitative data were analyzed using descriptive statistics.

Results

In all, 50 individuals participated in interviews (61.7% participation rate), and 37 participated in nine focus groups (75.5% participation rate). Most were White (72%, 73%), had a mean age of 45 and 48 years, and had a unilateral amputation (84%, 59%), respectively. Participants conceptualized upper extremity vascularized composite allotransplantation success as transplant outcomes: (1) restoring function and sensation to enable new activities; (2) accepting the transplanted limb into one's identity and appearance; (3) not having transplant rejection; (4) attaining greater quality of life compared to prosthetics; and (5) ensuring benefits outweigh risks. Participants rated their most important upper extremity vascularized composite allotransplantation outcomes as follows: not having transplant rejection, not developing health complications, grasping objects, feeling touch and temperature, and accepting the upper extremity vascularized composite allotransplantation into your identity.

Conclusion

Individuals with upper extremity amputations maintain several conceptions of vascularized composite allotransplantation success, spanning functional, psychosocial, clinical, and quality of life outcomes. Providers should address patients' conceptions of success to improve informed consent discussions and outcomes reporting for upper extremity vascularized composite allotransplantation.

Patient preferences of patient selection criteria for upper extremity vascularized composite allotransplantation: A qualitative study

Background

Upper extremity vascularized composite allotransplantation is a life-enhancing reconstructive treatment option that aims to improve recipients' quality of life and maximize function. This study assessed upper extremity vascularized composite allotransplantation patient selection criteria perceptions among individuals with upper extremity limb loss. The perceptions of individuals with upper extremity limb loss on patient selection criteria may enable vascularized composite allotransplantation centers to improve criteria to avoid mismatched expectations about the posttransplant vascularized composite allotransplantation experience and outcomes. Realistic patient expectations may increase patient adherence, improve outcomes, and reduce vascularized composite allotransplantation graft loss.

Methods

We conducted in-depth interviews with civilian and military service members with upper extremity limb loss and upper extremity vascularized composite allotransplantation candidates, participants, and recipients from three US institutions. Interviews assessed perceptions of patient selection criteria for suitability as a candidate for upper extremity vascularized composite allotransplantation. Thematic analysis was used to analyze qualitative data.

Results

A total of 50 individuals participated (66% participation rate). Most participants were male (78%), White (72%), with a unilateral limb loss (84%), and a mean age of 45 years. Six themes emerged regarding upper extremity vascularized composite allotransplantation patient selection criteria, including support for candidates who: (1) are of younger age, (2) are in good physical health, (3) have mental stability, (4) are willing to "put in the work," (5) have specific amputation characteristics, and (6) have sufficient social support. Patients had preferences about selecting candidates with unilateral versus bilateral limb loss.

Conclusions

Our findings suggest that numerous factors, including medical, social, and psychological characteristics, inform patients' perceptions of patient selection criteria for upper extremity vascularized composite allotransplantation. Patient perceptions of patient selection criteria should inform the development of validated screening measures that optimize patient outcomes.

Clinical study of tooth shade lightening from dentist-supervised, patient-applied treatment with two 10% carbamide peroxide gels

PURPOSE

Prescribed, patient-applied tooth lightening agents, or nightguard vital bleaching, typically utilizes a 10% carbamide peroxide agent applied during nocturnal hours. The purpose of this randomized double-blind study was to compare the amount of tooth color change in two groups of subjects using dentist-supervised, patient-applied 10% carbamide peroxide gel.

MATERIALS AND METHODS

One group used Opalescence (Ultradent Products Inc., South Jordan, Utah) and the other NiteWhite Excel (Discus Dental, Inc., Los Angeles, California). Evaluation of tooth color for the six maxillary anterior teeth was done using a Vita shade guide at baseline, 1, 2, and 4 weeks. Subjects were instructed to apply the gel nocturnally using a custom-made soft tray 8 hours per day for 2 weeks. The 16 tabs of the shade guide were ranked according to value from darkest to lightest. The number (1-16) that correlated to the shade tab selected as the match for each tooth was the outcome variable. A Kruskal-Wallis one way analysis of variance on ranks was used.

RESULTS

The test revealed no statistically significant difference between Opalescence and NiteWhite Excel for lightening the teeth (p = .807). The color change was still significant after 2 weeks without further bleaching activity. The baseline evaluation of the maxillary incisors and canines for all subjects, regardless of group, demonstrated a significant shade difference, with the canines being darker. This difference was not seen after 2 weeks of active bleaching or at the 4-week evaluation.

CLINICAL SIGNIFICANCE

In this study comparing bleaching products, patients using Opalescence and NiteWhite Excel experienced a significant change in the color of their teeth relative to baseline values after 2 weeks of active treatment.

Systemic lupus erythematosus: a review for dental professionals

Systemic lupus erythematosus is a chronic, autoimmune disorder of unknown etiology with an annual incidence of 2 to 8 cases per 100,000 adults. Symptoms include fevers, arthralgias, and a characteristic rash over the cheeks and nose. More serious manifestations involve the cardiac, renal, and central nervous systems. Due to the valvular damage associated with SLE, prophylactic antibiotic premedication is recommended prior to invasive dental procedures. Drug therapy consists of nonsteroidal anti-inflammatory agents, antimalarials, and corticosteroids. Appropriate dental management of these patients requires an understanding of the etiology, clinical manifestations, current treatment recommendations, and psychological aspects of the disease.

Assessing the effects of 10 percent carbamide peroxide on oral soft tissues

To examine the effects of a 10 percent carbamide peroxide bleaching gel on the oral soft tissues, the authors conducted a prospective, double-blind, placebo-controlled clinical investigation. Fifty-two patients completed a two-week treatment regimen, applying either a placebo or a 10 percent carbamide peroxide gel in a soft tray for eight hours a day. Clinicians examined the participants' oral soft tissues at baseline and one week, two weeks and six weeks after the first treatment. The examiners recorded the Silness and Löe plaque and gingival indexes, nonmarginal gingival index and nongingival oral mucosal index at each examination. The data collected at these intervals did not indicate that any soft tissue damage had occurred as a result of the bleaching regimen.

Role of LH pulse amplitude in controlling rat ovarian oestradiol-17 beta secretion in vitro

Ovaries from di-oestrous rats were removed and placed in perifusion culture: 4-6 ovaries were cultured for 3 h with (1) no gonadotrophin; (2) tonic FSH (200 ng/ml); (3) tonic LH (30 ng/ml); (4) tonic FSH and tonic LH; (5) tonic FSH and hourly pulses of 40 ng LH/ml; or (6) tonic FSH and hourly pulses of 50 ng LH/ml. The total amount of LH administered was 3060 ng LH, regardless of mode of delivery. Perifusate was collected every 10 min and assayed for oestradiol-17 beta by RIA. The total amount of oestradiol-17 beta secreted was not altered by any treatment except when LH was administered in hourly pulses with an amplitude of 50 ng/ml; the total amount of oestradiol-17 beta secreted in 3 h was increased by 300% (P less than 0.05). Without gonadotrophic stimulation, oestradiol-17 beta was secreted at a constant rate (4.48 +/- 0.21 pg/mg 10 min-1). Tonic gonadotrophin stimulation did not alter this pattern. However, pulses of 50 ng LH/ml but not 40 ng LH/ml resulted in periodic increases in oestradiol-17 beta secretory rates. Thus, oestradiol-17 beta secretion is stimulated by LH pulses with the degree of stimulation dependent, in part, on the amplitude and/or the rate of change of the LH pulse.