Self-reported pain or injury from equipment used on military deployment.

BACKGROUND: Information about pain and injury from equipment on a particular deployment is not disaggregated in the literature; thus, the nature of the issue is unclear. AIMS: To determine the prevalence of pain or injury during a particular deployment that military personnel attributed to equipment they used on this deployment; and to document the types of equipment they identified, the type of pain or injury and how they thought the pain or injury occurred. METHODS: This paper analyses data from a deployment and health survey of Australian Defence Force personnel. The participants are 8932 personnel who deployed to Iraq and 6534 who deployed to Afghanistan. Participants indicated whether they experienced pain or injury from equipment they used on deployment and detailed their experiences in response to an open-ended question (n = 563). RESULTS: Sixteen per cent of Iraq-deployed and 21% of Afghanistan-deployed participants reported pain or injury from equipment they used on deployment. Body armour was the most common equipment identified; however, a wide range of equipment was related to pain or injury. A new finding is that pain or injury related to armour was attributed to its wear in vehicles and during vehicle ingress or egress. CONCLUSIONS: Knowledge of the nature of pain or injury related to equipment used on deployment may help inform improved designs and practices to reduce or prevent avoidable harm to serving personnel.

Normal Tissue Complication Probability (NTCP) Modelling of Severe Acute Mucositis using a Novel Oral Mucosal Surface Organ at Risk.

AIMS: A normal tissue complication probability (NTCP) model of severe acute mucositis would be highly useful to guide clinical decision making and inform radiotherapy planning. We aimed to improve upon our previous model by using a novel oral mucosal surface organ at risk (OAR) in place of an oral cavity OAR. MATERIALS AND METHODS: Predictive models of severe acute mucositis were generated using radiotherapy dose to the oral cavity OAR or mucosal surface OAR and clinical data. Penalised logistic regression and random forest classification (RFC) models were generated for both OARs and compared. Internal validation was carried out with 100-iteration stratified shuffle split cross-validation, using multiple metrics to assess different aspects of model performance. Associations between treatment covariates and severe mucositis were explored using RFC feature importance. RESULTS: Penalised logistic regression and RFC models using the oral cavity OAR performed at least as well as the models using mucosal surface OAR. Associations between dose metrics and severe mucositis were similar between the mucosal surface and oral cavity models. The volumes of oral cavity or mucosal surface receiving intermediate and high doses were most strongly associated with severe mucositis. CONCLUSIONS: The simpler oral cavity OAR should be preferred over the mucosal surface OAR for NTCP modelling of severe mucositis. We recommend minimising the volume of mucosa receiving intermediate and high doses, where possible.

von Willebrand disease in a pediatric-based population--comparison of type 1 diagnostic criteria and use of the PFA-100 and a von Willebrand factor/collagen-binding assay.

Definitive diagnosis of type 1 von Willebrand Disease (VWD) remains a problem. Provisional consensus guidelines for the diagnosis of definite and possible type 1 VWD were prepared by the Scientific Subcommittee on von Willebrand factor (VWF) of the Scientific and Standardization Committee (SSC) of the International Society on Thrombosis and Haemostasis (ISTH) during the 1996 annual meeting for the specific purpose of further evaluation in retrospective and prospective studies by a Working Party on Diagnostic Criteria (1996 Annual Report of the SSC/ISTH Subcommittee on VWF). In the first phase of this study, we compared 2 definitions of type 1 VWD. each with 3 criteria: significant bleeding history, laboratory investigations, and family history. Using the ISTH consensus guidelines for type 1 VWD definition, significantly fewer patients were diagnosed with definite type 1 disease as compared to our "in house" Hospital for Sick Children (HSC) criteria (4 vs. 31). While we recognize that the provisional ISTH consensus guidelines were not intended for clinical use, we believe that the results of our studies are of interest and will assist in any future refinements to the ISTH guidelines. In the second phase of this study, we investigated the utility of 2 new tests, a laboratory screening test and a functional test, for VWD in our well characterized, pediatric-based population. The Platelet Function Analyzer (PFA-100) provides an in vitro measure of primary hemostasis under conditions of high shear, using disposable cartridges containing collagen and either epinephrine or ADP. All tested subjects with types 2 or 3 VWD had prolonged PFA-100 closure times (CTs) with both cartridge types (n = 17) and prolonged bleeding times (n = 14). In subjects with definite type 1 VWD, 20/24 (83%) had prolonged CTs with the collagen/ADP cartridge (19/24 (79%) with collagen/epinephrine), compared with 7/26 (27%) with prolonged bleeding times. In subjects with definite types 1, 2, or 3 VWD, collagen/ADP CTs were abnormal in 37/41 subjects, giving an overall sensitivity of 90%. With this high sensitivity, the PFA-100 is a better screening test for VWD than the bleeding time. We also tested a VWF collagen-binding assay (VWF:CBA) as a functional test for VWF, in comparison with the more routinely-used ristocetin cofactor assay (VWF:RC0). The VWF:CBA is based on an ELISA technique, which has the potential to be more reproducible than the VWF:RC0. We found that the VWF:CBA detected 43/49 (88%) subjects with definite types 1, 2, or 3 VWD, performing as well as the VWF:RC0, that detected 42/48 (88%). We also showed that, used in conjunction with VWF antigen levels, the VWF:CBA may be useful in classification of VWD subtypes.

Epi Info: a general-purpose microcomputer program for public health information systems.

Epi Info is a general-purpose set of computer programs for word processing, database management, statistics, and graphics developed over the past five years at the Centers for Disease Control and the World Health Organization. The programs allow rapid questionnaire construction, data entry, and analysis during epidemic investigation. Both data entry and analysis can be programmed to provide customization and automatic operation for more permanent systems, such as those for disease or injury surveillance. Epi Info is in the public domain and copies may be freely distributed. It requires an IBM-compatible micro-computer with at least 512 kilobytes of memory. Translations into French and Spanish are in progress; a translation kit is available to facilitate translation into other languages.

Medical and nutritional aspects of intractable diarrhea.

Diarrhea can be due to at least five pathogenetic mechanisms. Major examples of each are presented to better illustrate each type of diarrhea and to provide a springboard for discussion of the nutritional management of each class of diarrhea. Certainly, specific diseases require specific therapies, such as avoidance of gluten in adult coeliac disease, but the major dietary/nutritional alterations and subsequent treatment are similar for each class of disease. Nowhere in medicine and nutrition is an admonition to the health care team more important and more proper than in the treatment of chronic diarrheas: The feeding of healthy man, as well as the diet of the sick cannot be left to chance, guided by the appetite, or ruled by tradition, but can be safely directed only according to the laws of digestion and metabolism.

Diphallia and hindgut duplication.

Diphallia is a rare congenital condition that presents in many, varied ways. Associated anomalies are to be expected. These anomalies should be sought out and treated as early in the patient's life as possible because they are the principal cause of mortality in these individuals. Half the patients reviewed by Ravitch in 1953 with duplication of the colon and genital tracts died of intestinal complications. Definitive genital repair should be done at an age where the anatomy is of large enough caliber for eased surgical manipulation, but prior to the age of recall. From our experience with hypospadias repair, the optimal age seems to be 12 months of age. Each case must be treated individually in order to achieve the best functional and aesthetic result.

The brow slide: a technique for the aesthetic treatment of eyebrow tumors.

Skin neoplasms involving the eyebrow are not an uncommon problem. Standard surgical resections that depend on elliptical excision and closure tend to either remove an excessive amount of brow or place scars in an unfavorable position. We present a simple technique that allows for maximal brow preservation, alignment of remaining brow, and a minimal amount of exposed scars.

Using a resin-modified glass ionomer as an occlusal sealant: a one-year clinical study.

The authors compared the retention and clinical performance of a resin-modified glass ionomer, or RMGI, restorative and a light-cured resin sealant. The first permanent molars on one side of the dental arch in 50 children were sealed with an RMGI, and the same teeth on the other side were sealed with a resin sealant. At baseline, six months after placement and one year after placement, examiners documented sealant retention, secondary caries, marginal discrepancy and marginal staining. In general, the RMGI appeared to wear markedly. At one year, the retention of the RMGI was significantly less than the resin, but the RMGI had significantly fewer marginal discrepancies. There were no significant differences in caries development or marginal discoloration.

Platelet function in autoimmune (idiopathic) thrombocytopenic purpura.

Platelets play an essential role in the formation of haemostatic plugs. The quantitative defect of platelets in autoimmune (idiopathic) thrombocytopenic purpura (ITP) can result in bleeding complications, but most ITP patients have platelets with normal or enhanced function. Platelets in ITP are large, young, so-called "stress" platelets with increased platelet-associated autoimmune antibody (immunoglobulin G). Young stress platelets are more functional platelets, and their presence may account for bleeding times in ITP patients that are shorter than would be predicted on the basis of the patients' (low) platelet counts. Some ITP patients have significant mucocutaneous bleeding with platelet counts >50 x 10(9) l(-1); this may be due to qualitative platelet dysfunction (e.g. brought about by inhibitory antiplatelet autoantibodies).

A comparison of a hybrid light-cured glass-ionomer base and liner vs. a light-cured resin tooth fragment attachment.

PURPOSE: The purpose of this study was to compare the dislodgement strengths and fracture types for reattached tooth fragments using a light-cured composite resin material, a hybrid light-cured glass ionomer base, and a hybrid light-cured glass ionomer liner. METHODS: Seventy-five bovine incisor teeth were fractured, randomly divided into three groups of equal number, and then luted back together with three different materials (Universal Bonding Agent/TPH Composite Resin; VariGlass VLC Base; and VariGlass VLC Liner: LD Caulk Div Dentsply Int Inc, Milford, DE). The reattached fragments were subjected to thermocycling with a 40 degrees C differential and then were loaded until the force required to dislodge the fragment was reached. RESULTS: The mean dislodgement strengths were 36.8 (+/- 25.6) kg for the composite resin, 36.4 (+/- 26.7) kg for the glass ionomer base, and 31.4 (+/- 29.5) kg for the glass ionomer liner. Cohesive fractures occurred in 73% of the dislodgements. CONCLUSIONS: There was no statistically significant difference demonstrated (P < 0.05) between the three groups in terms of both dislodgement strength and fracture type.

Progression of interproximal caries in the primary dentition.

While studies have addressed the diagnosis and progression of interproximal carious lesions within a primary tooth, few studies have addressed the development of proximal lesions in adjacent primary molars. The purpose of this study was to examine retrospectively the long term interproximal caries progression in primary molar teeth. Dental records of 150 children were retrospectively reviewed, 76 from a university pediatric dentistry clinic and 74 from a pediatric dentistry private practice. Out of the 387 teeth initially diagnosed with proximal caries, the combined university and private practice results for timing of the development of proximal lesions on adjacent tooth surfaces showed the following: simultaneous development-162 (41.9%); 1 to 24 months-65 (16.8%); 24 to 60 months-40 (10.3%); never-120 (31.0%). The combined results for formation of proximal caries in posterior quadrants showed that out of the 150 patients, the timing for development of additional quadrants with proximal caries was as follow: simultaneous development: 77 (51.3%); 1 to 24 months 31, (20.7%); 24 to 60 months 25, (16.7%); never 17 (11.3%). The conclusions of the study are that 69% of the primary molar teeth with proximal caries developed caries on the adjacent proximal surface and 89% of the patients who developed a proximal carious lesion on a primary molar tooth within one quadrant developed another primary molar proximal lesion in another quadrant.

Histological evaluation of electrosurgery and formocresol pulpotomy techniques in primary teeth in dogs.

The purpose of this study was to compare pulpal and periapical tissue reactions to electrosurgery versus formocresol pulpotomy techniques in the primary teeth of dogs. The study was conducted on 33 primary teeth of three mongrel dogs between the ages of one to three months. Each dog had three teeth treated by Formocresol Pulpotomy with Mechanical Coronal Pulp Removal (FC), three teeth treated by Electrosurgery Pulpotomy with Mechanical Coronal Pulp Removal (ES/MCPR), three teeth treated by Electrosurgery Pulpotomy with Electrosurgical Coronal Pulp Removal (ES/ECPR), and two teeth serving as untreated Controls. Dogs one, two and three were sacrificed performing the pulpotomies at two, four and six weeks, respectively. The pulp, periapical tissue and after surrounding bone were submitted to histological examination and the histological reaction was recorded. The results were fourteen out of 18 unfavorable and zero out of three favorable histological reactions occurred in the FC treated teeth. Six out of 18 unfavorable and one out of three favorable histological reactions occurred in the ES/MCPR treated teeth. Nine out of 18 unfavorable and two out of three favorable histological reactions occurred in the ES/ECPR treated teeth. One out of 18 unfavorable and zero out of three favorable histological reactions occurred in the untreated Control teeth. The conclusion of this study is that of the three experimental groups, the teeth treated by Electrosurgery Pulpotomy with either Mechanical or Electrosurgical Coronal Pulp Removal exhibited less histopathological reaction than the teeth treated by Formocresol Pulpotomy.

The resuscitation status of a patient: a constant dilemma.

Since the first description of closed chest cardiac massage in 1960, healthcare has evolved considerably. The modern-day skill and expertise of both doctors and nurses in cardiopulmonary resuscitation (CPR) techniques are now supported by an advanced medical technology. Indeed, CPR is now perceived as the definitive life-saving procedure. However, paradoxically, it has also prolonged the process of dying and denied many patients a dignified and peaceful death. It has also denied the patient's loved ones the opportunity to be present at the time of death. The main focus of this article is to explore the current ethical issues in clinical practice relating to determining the resuscitation status of patients. Attention will also be given to patient advocacy, and the nurse's role in supporting this concept.

Indiana infant-toddler dental care survey.

The purpose of this project was to survey Indiana dentists concerning dental care for Indiana infants and toddlers. Dental care issues covered were the age for a child's first dental visit, frequency of rampant or nursing caries cases examined, and dental referral sources for infants and toddlers. The survey also helped determine the dentist's perception of parents' attitudes toward services recommended by the dentist. A twelve question survey was mailed to 2006 general and pediatric dentists in the State of Indiana. The results of the survey were: 1. A large percentage of Indiana dental practitioners do not recommend the first dental visit or examine children for their dental visit until the child is more than one year of age. 2. A majority of Indiana dental practitioners see children with nursing caries or rampant caries on a monthly basis. 3. The majority of Indiana dental practitioners refer children with nursing caries to pediatric dentists for treatment. 4. Although the full treatment plan may undergo some modification based on various parental concerns, a majority of practitioners do not experience difficulty in obtaining treatment plan acceptance for nursing or rampant caries cases.

Neurocognitive function after (chemo)-radiotherapy for head and neck cancer.

Radical radiotherapy has a pivotal role in the treatment of head and neck cancer (HNC) and cures a significant proportion of patients while simultaneously sparing critical normal organs. Some patients treated with radical radiotherapy for HNC receive significant radiation doses to large volumes of brain tissue. In fact, intensity-modulated radiotherapy techniques for HNC have been associated with a net increase in irradiated brain volumes. The increasing use of chemoradiotherapy for HNC has additionally exposed this patient population to potential neurotoxicity due to cytotoxic drugs. Patients with HNC may be particularly at risk for adverse late brain effects after (chemo)-radiotherapy, such as impaired neurocognitive function (NCF), as risk factors for the development of HNC, such as smoking, excess alcohol consumption and poor diet, are also associated with impaired NCF. The relatively good survival rates with modern treatment for HNC, and exposure to multiple potentially neurotoxic factors, means that it is important to understand the impact of (chemo)-radiotherapy for HNC on NCF, and to consider what measures can be taken to minimise treatment-related neurotoxicity. Here, we review evidence relating to the late neurotoxicity of radical (chemo)-radiotherapy for HNC, with a focus on studies of NCF in this patient population.