Triclosan-coated sutures and sternal wound infections: a prospective randomized clinical trial.

Surgical site infection is a common complication following cardiac surgery. Triclosan-coated sutures have been shown to reduce the rate of infections in various surgical wounds, including wounds after vein harvesting in coronary artery bypass grafting patients. Our purpose was to compare the rate of infections in sternotomy wounds closed with triclosan-coated or conventional sutures. A total of 357 patients that underwent coronary artery bypass grafting were included in a prospective randomized double-blind single-center study. The patients were randomized to closure of the sternal wound with either triclosan-coated sutures (Vicryl Plus and Monocryl Plus, Ethicon, Inc., Somerville, NJ, USA) (n = 179) or identical sutures without triclosan (n = 178). Patients were followed up after 30 days (clinical visit) and 60 days (telephone interview). The primary endpoint was the prevalence of sternal wound infection according to the Centers for Disease Control and Prevention (CDC) criteria. The demographics in both groups were comparable, including age, gender, body mass index, and rate of diabetes and smoking. Sternal wound infection was diagnosed in 43 patients; 23 (12.8%) sutured with triclosan-coated sutures compared to 20 (11.2%) sutured without triclosan (p = 0.640). Most infections were superficial (n = 36, 10.1%), while 7 (2.0%) were deep sternal wound infections. There were 16 positive cultures in the triclosan group and 17 in the non-coated suture group (p = 0.842). The most commonly identified main pathogens were Staphylococcus aureus (45.4%) and coagulase-negative staphylococci (36.4%). Skin closure with triclosan-coated sutures did not reduce the rate of sternal wound infection after coronary artery bypass grafting. (clinicaltrials.gov: NCT01212315).

Latent classes in diagnoses among psychiatric inpatients predicting mortality and imprisonment - a nationwide cohort study.

PURPOSE: Identify risk factors of death or imprisonment within classes defined by demographic factors and diagnoses within one year of first psychiatric admission. METHODS: Nationwide data was obtained from hospital registers from psychiatric hospitals in Iceland 1983-2007. Mortality and cause of death as well as information about imprisonments during the study period, and discharge diagnoses for the first year after initial admission were obtained for each individual. Individuals aged 18 during the study period with at least one year of follow-up were included. Latent Class Analysis was used to identify groups with distinguishable risk of either being alive, dead or having been imprisoned at the end of follow-up. RESULTS: Among psychiatric patients, 4677 were included, average age was 27 years (range 18-43). Four latent classes were identified with different risks of adverse outcomes. Class B (16%), predominantly males with substance use disorder (SUD) diagnoses, had highly increased risk of imprisonment and death accounting for 85 and 34% of these outcomes, respectively. Class A (12%), all with alcohol use disorder, had similar mortality rate as the general population and no imprisonments. Class C (23%) were younger at first admission with some SUD and increased risk of mortality. Class D (46%) had increased mortality rate, SUDs were rare but depression common. CONCLUSIONS: Risk of mortality and criminal trends among psychiatric inpatients can be described as distinct clusters of risk factors present at first admission to a psychiatric hospital. Treatment and interventions to reduce mortality and criminality should take these risk differences into account.

Methylphenidate disintegration from oral formulations for intravenous use by experienced substance users.

BACKGROUND AND AIMS: Methylphenidate (MPH) is a prescription stimulant used to treat attention-deficit hyperactivity disorder. MPH is currently the preferred substance among most intravenous (i.v.) substance users in Iceland. Four types of MPH preparations were available in Iceland at the time of study: Immediate-release (IR), sustained-release (SR), osmotic controlled-release oral delivery (OROS) tablet and osmotic-controlled release (OCR). MPH OROS has previously been rated the least desirable by i.v. users and we hypothesized that this was associated with difficulty of disintegrating MPH from OROS formulation. The aim of the study was to measure the amount of MPH and the viscosity of the disintegrated solutions that were made from the four MPH formulations by four i.v.-users and non-users. METHODS: A convenience sample of four i.v. substance users and 12 non-users. Non-users imitated the methods applied by experienced i.v. substance users for disintegrated MPH formulations. RESULTS: Both groups managed to disintegrate over 50% of MPH from IR and SR formulations but only 20% from OROS (p<0.0001). The viscosity of the disintegrated MPH was significantly higher for MPH OROS and MPH OCR and the preparation was significantly more time-consuming than for the other MPH samples. No differences were observed between users and non-users. CONCLUSIONS: To our knowledge, this is the first investigation of viscosity and the amount of disintegrated MPH from prescription drugs for i.v. use. The results indicate that the ease of disintegration, amount of MPH and viscosity may explain the difference in popularity for i.v. use between different MPH formulations.

[The dental state of old-age pensioners resident in homes for the elderly and long-stay geriatric units in Reykjavík]. / Fjöldi og ástand tanna ellilífeyrispega sem voru vistmenn á elliheimilum eda langlegusjúklingar á sjúkrahúsum í Reykjavík.

In 1984 the dental state was clinically investigated in a random sample of 400 old-age pensioners, 67 years or older, who were either inmates of old people's residential or nursing homes or long-term patients in geriatric departments of the hospitals in Reykjavík. Decayed, missing and filled teeth were recorded in accordance with criteria suggested by WHO. Of the participants 10% (27 males and 13 females) were dentulous with a mean number of 9.9 teeth. The mean number of remaining teeth in dentate subjects was higher in the mandible than in the maxilla. The mean number of remaining teeth per person decreased with increasing age and was higher in males than females in 4 out of 5 age groups. The teeth most commonly retained were the canines and lateral incisors in the mandible and central incisors and canines in the maxilla. Only 0.8% of the sample had greater than or equal to 10 teeth in each dental arch.

[Incidence and estimated need for complete dentures in elderly inhabitants in nursing homes and long-term patients in hospital geriatric units in Reykjavik in 1984]. / Tídni og áaetlud börf heilgóma hjá ellilífeyrisbegum sem voru vistmenn á hjúkrunar- og dvalarheimilum fyrir alfrada eda langlegusjúklingar á sjúkrahúsum i Reykjavík árid 1984.

In 1984 prevalence and objective and subjective need for complete dentures was investigated in a random sample of 400 old-age pensioners, 67 years and older, who were either inmates of old people's residential or nursing homes or long term patients in geriatric departments of the hospitals in Reykjavík. Complete upper and lower dentures were worn by 80.5% of the inmates, a complete maxillary denture alone by 7.5% and a complete mandibular denture alone by 0.5%. Prevalence of denture wearing was significantly higher in females than males and higher in those who, before admission to the institutions, lived in Reykjavík or other towns and villages rather than in inmates coming from rural districts. The difference between estimated objective (58%) and subjective (19.2%) need for complete dentures was great.

[The ability of elderly institutionalized pensioners in Reykjavik in maintaining and carrying out oral hygiene procedures in 1984]. / Prif tanna og heilgóma hjá ellilífeyrispegum sem voru vistmenn á hjúkrunar- og dvalarheimilum fyrir aldrada eda langlegusjúklingar á sjúkrastofnunum í Reykjavík árid 1984.

In 1984 a random sample of 400 institutionalized old-age pensioners, 67 years and older, was interviewed on oral hygiene habits. Complete denture cleanliness was also studied by using a plaque detector to disclose plaque on the fitting surface of the maxillary denture. Based on the distribution of plaque a grading system using three categories (excellent, fair, poor) was applied to indicate complete denture cleanliness. About 94% of dentulous and 88.7% of edentulous respondents claimed that they were able to take care of their oral hygiene themselves. The proportion of dentulous subjects that cleaned their teeth at least once a day was 66.7%. A great majority (92.4%) of edentulous pensioners reported that they cleaned their complete dentures once a day or more often and women cleaned their dentures more frequently than men. Nevertheless cleanliness was graded excellent in only 14.4% of the complete dentures. This seems to indicate a need for increased education on the importance of a good oral hygiene and that institutionalized pensioners should receive more help with their daily oral hygiene.

[Institutionalized elderly in Reykjavik in 1984. Their opinions of dental visits, need for dental service and possible changes in dental service and third party payments]. / Ellilífeyrispegar á stofnunum í Reykjavík árid 1984. Tatnnlaeknisheimsóknir, álit á tannlaeknispjónustunni, eigid mat ápörf fyrir tannlaeknispjónustu og álit á hugsanlegum breytingum á pjónustu tannlaekna og tryggingagreidslum.

In 1984 an investigation was done among a random sample of 400 old-age pensioners, 67 yrs, and older, who were either inmates of old people's residential or nursing homes or long-term patients in geriatric departments at the hospitals in Reykjavík. A dentist asked all participants standardised questions, among which were: questions concerning dental visiting habits; opinion on the dental public health system; subjective estimation on own need for dental services; opinion on the services rendered by the dental profession; and refunds of dental fees by the public health system. During the last twelve month period only 16.6% had visited a dentist and 34% had not gone to a dentist for more than 20 years. Of those who had made use of dental services during the last 5-10 years, 79.6% said they were satisfied. Barely 75% considered themselves in need of dental services, and 67.6% claimed that they would not seek dental services more frequently if they were made available in the institution, or if free transportation were available to the dentist's office. Only 35.9% said that they would make use of free dental checkups, while 82.2% however were in favour of free health services for old age pensioners. For statistical analysis chi-square at 5% level was used, comparing the answers by sex, age, and institution. There was no statistically significant difference with the exception of difference between institutions with regard to a question of free dental services (0.005 less than p less than 0.01). This question however did not give a significant difference between the sexes or the two different age groups.