The Effect of a Radiation Positioning Stent (RPS) in the Reduction of Radiation Dosage to the Opposing Jaw and Maintenance of Mouth opening after Radiation Therapy.

The effect of a radiation positioning stent (RPS) in radiation dosage reduction to the opposing jaw and maintenance of mouth opening was audited. 55 Head and Neck cancer patients who received radiotherapy were reviewed. Radiation dosages at similar points in the primary/opposing jaws were measured along with the mouth opening. Results showed a significant reduction in the radiation dosage to the opposing jaw in patients given the RPS. Mouth opening was generally maintained in patients given the RPS (77.7% improvement in mouth opening) compared to patients without RPS. Patients undergoing radiotherapy who had an RPS showed a significant reduction in radiation dosage to the opposing jaw and maintained their mouth opening in the short-term.

Changing stroke mortality trends in middle-aged people: an age-period-cohort analysis of routine mortality data in persons aged 40 to 69 in England.

BACKGROUND: In the UK, overall stroke mortality has declined. A similar trend has been seen in coronary heart disease, although recent reports suggest this decline might be levelling off in middle-aged adults. AIM: To investigate recent trends in stroke mortality among those aged 40-69 years in England. METHODS: The authors used routine annual aggregated stroke death and population data for England for the years 1979-2005 to investigate time trends in gender-specific mortalities for adults aged 40 to 69 years. The authors applied log-linear modelling to isolate effects attributable to age, linear 'drift' over time, time period and birth cohort. RESULTS: Between 1979 and 2005, age-standardised stroke mortality aged 40 to 69 years dropped from 93 to 30 per 100,000 in men and from 62 to 18 per 100,000 in women. Mortality was higher in older age groups, but the difference between the older and younger age groups appears to have decreased over time for both sexes. Modelling of the data suggests an average annual reduction in stroke deaths of 4.0% in men and 4.3% in women, although this decrease has been particularly marked in the last few years. However, we also observed a relative rate increase in mortality among those born since the mid-1940s compared with earlier cohorts; this appears to have been sustained in men, which explains the levelling off in the rate of mortality decline observed in recent years in the younger middle-aged. CONCLUSIONS: If observed trends in middle-aged adults continue, overall stroke mortalities may start to increase again.

Can early onset bone loss be effectively managed in post-stroke patients? An integrative review of the evidence.

BACKGROUND: bone loss post-stroke can lead to an increased risk of fracture. Fractures compound the effects of a stroke, resulting in greater dependency for the individual and an increased burden for health and social care. OBJECTIVES: to identify risk factors for bone loss post-stroke and appraise bone loss or fracture risk reduction interventions. To develop a research agenda that informs the design and development of risk reduction strategies. DESIGN: an integrative review. METHODS: the search strategies used in Medline, Embase, AMED and CINAHL from 1966 to July 2006 identified 530 records. Ninety-nine papers with a focus on risk factors or interventions to prevent bone loss or fractures post-stroke were identified. Hand searching and scoping grey literature produced 59 additional papers. Data analysis, including data reduction and data display using matrices, enabled patterns and themes to be derived from differing study designs. RESULTS: risk factors for bone loss post-stroke are reduced mobility, vitamin D deficiency, gender and time since stroke. Early mobilisation post-stroke may reduce bone loss, and so avoid fractures, but evidence is needed. Providing vitamin D supplements and Bisphosphonates in post-stroke patients tends to reduce bone loss, but larger treatment trials are required. CONCLUSIONS: the evidence base for bone loss management post-stroke is limited. Large, prospective, multi-centre, longitudinal studies are needed to clarify optimum treatments to reduce post-stroke bone loss, and test the effects on clinical outcomes. A 'skeletal health' checklist to aid implementation of treatments within stroke rehabilitation has been suggested but not yet developed.