Differences in triage and medical confidentiality between prisons of Belgium and the Netherlands.

Objectives: The aim of this study is to describe the opinions of prison doctors, and to compare the primary health care in prisons between Belgium and the Netherlands.Methods: Structured interviews, audio-recorded and transcribed verbatim, were conducted with prison doctors in Dutch-speaking prisons in Flanders/Belgium and in the Netherlands. Two investigators analysed the content of the interviews and discussed each individual interview.Results: In total 37 interviews were conducted in 28 prisons (14 in each country). In Belgium, 14 of 17 prison doctors, compared to 1 of 12 in the Netherlands, experienced higher time pressure during their consultations in prison, compared to their private medical work (P < 0.001). In the Netherlands, compared to Belgium, there is more access to psychiatric support (14/14 vs 11/22, P = 0.002), psychological care (13/13 vs 7/22, P < 0.001), and interpreter facilities (15/22 vs 0/14, P < 0.001). Prison doctors in both countries agree that the possibility for a strictly personal encounter with the patient - without the presence of other medical staff - can be very useful (21/22 in Belgium vs 15/15 in the Netherlands). In Belgium, individual consultations with the detainee are not possible.Conclusions: Compared to the situation in the Netherlands, the medical work of prison doctors in Belgium is characterized by time pressure and lack of psychiatric and psychological support. The absence of interpreter facilities in Belgium handicaps the quality of the primary health care in prisons. In addition, the lack of private encounters with a doctor in Belgian prisons violates the patient rights of the detainee.

Effects of Whole Body Vibration in Patients With COPD.

BACKGROUND: Whole body vibration training (WBVT) improves muscle force in healthy subjects. Resistance training (RT) is an important component of a pulmonary program. AIM: To investigate the effects of either 12 weeks WBVT or RT, both provided after 15 min of aerobic training as warming up. METHODS: COPD patients, referred for pulmonary rehabilitation, were randomized to either a WBVT or a conventional RT group. Primary outcome was the change in 6 Minute Walking Distance (6MWD) after 12 weeks. Maximum exercise capacity (Wmax), quadriceps force (QF), quality of life (QoL) and number of responders, defined as the percentage of patients reaching the minimally clinically important difference (MCID) for the aforementioned outcome measurements were the secondary outcomes. Data are expressed as medians (interquartile range). RESULTS: 62 patients with COPD were included. After WBVT, 6MWD improved by 35 (-14-76) m (p = 0.003), Wmax by 7 (2-23) Watt (p = 0.001), QoL by 13 (4-25) points (p = 0.002) and QF by 9 (-16-29) Nm (NS). In the RT-group, 6MWD, Wmax, QoL and QF increased significantly, with 60 (-13-96) m (p < 0.001), 12 (8-18) Watt (p < 0.001), 11 (3-16) points (p = 0.002) and 12 (-3-44) Nm (p = 0.009), respectively. The MCID for 6MWD (54 m) was reached by 8/26 patients in the WBVT-group and by 16/25 patients in RT-group (p = 0.05). No significant differences between groups were observed for the primary and secondary outcomes. CONCLUSIONS: WBVT after 15 min aerobic training enhances 6MWD, Wmax and QoL in COPD patients; however only 30% of patients reached the MCID for 6MWD.

Internal Spermatic Vein Insufficiency in Varicoceles: A Different Entity in Adults and Adolescents?

OBJECTIVE: The purpose of this study was to determine whether phlebographic features can be used to discriminate adult from adolescent varicocele. MATERIALS AND METHODS: Left and right internal spermatic venograms of 191 adolescents (< 17 years) and 224 adults (≥ 25 years) were anonymized and evaluated. Phlebographic radioanatomic features (valves, duplications, collaterals, and classifications) were compared and analyzed with univariate tests. RESULTS: Insufficiency of the left internal spermatic vein (ISV) was confirmed in 409 of the 415 (99%) patients. Adults had no spontaneous opacification of the ISV during venography twice as frequently as adolescents (p = 0.001), a complex outflow into the renal vein 2.2 times as often (p = 0.021), and significantly more collaterals (p = 0.030). Adolescents had a significantly lower number of competent valves and significantly more instances of nutcracker phenomenon (p = 0.001). According to the Bähren classification, the distribution of the types of ISVs was significantly different between adults and adolescents (p = 0.009). Insufficiency of the right ISV was encountered 2.4 times as frequently in adults as in adolescents (p < 0.001). In adults the maximum diameter of the ISV was significantly larger (p = 0.023). Bilateral ISV insufficiency was 2.2 times as frequent in adults (p < 0.001) as in adolescents. CONCLUSION: Left-sided varicoceles in adults are distinct from those in adolescents. In adults, reflux is likely to be induced via collateral pathways, whereas in adolescents congenital venous abnormalities are predominantly present. The higher prevalence and the greater diameter of a right insufficient ISV in adults, combined with the absence of venous anatomic differences, supports the hypothesis that right-sided varicocele is an evolutive disease.

Rehabilitation in patients with radically treated respiratory cancer: A randomised controlled trial comparing two training modalities.

INTRODUCTION: The evidence on the effectiveness of rehabilitation in lung cancer patients is limited. Whole body vibration (WBV) has been proposed as an alternative to conventional resistance training (CRT). METHODS: We investigated the effect of radical treatment (RT) and of two rehabilitation programmes in lung cancer patients. The primary endpoint was a change in 6-min walking distance (6MWD) after rehabilitation. Patients were randomised after RT to either CRT, WBVT or standard follow-up (CON). Patients were evaluated before, after RT and after 12 weeks of intervention. RESULTS: Of 121 included patients, 70 were randomised to either CON (24), CRT (24) or WBVT (22). After RT, 6MWD decreased with a mean of 38m (95% CI 22-54) and increased with a mean of 95m (95% CI 58-132) in CRT (p<0.0001), 37m (95% CI -1-76) in WBVT (p=0.06) and 1m (95% CI -34-36) in CON (p=0.95), respectively. Surgical treatment, magnitude of decrease in 6MWD by RT and allocation to either CRT or WBVT were prognostic for reaching the minimally clinically important difference of 54m increase in 6MWD after intervention. CONCLUSIONS: RT of lung cancer significantly impairs patients' exercise capacity. CRT significantly improves and restores functional exercise capacity, whereas WBVT does not fully substitute for CRT.

Tolerance of glue embolization under local anesthesia in varicoceles: a comparative study of two different cyanoacrylates.

PURPOSE: To find out whether in varicocele embolization the copolymer cyanoacrylate glue (NBCA-MS) has a better patient tolerance compared to the monomer n-butyl-2-cyanoacrylate (NBCA). MATERIALS AND METHODS: N=112 insufficient spermatic veins (left sided N=84, right sided N=28) diagnosed in N=83 adult males were prospectively randomized for blinded embolization with either NBCA N=54 (Histoacryl) or with NBCA-MS N=58 (Glubran2). Before, during and up to one week after embolization, patient discomfort was assessed by a standardized pain scale. Type, location and side of discomfort were noted. Statistical analysis was performed with the Mann-Whitney U-test, the McNemar test and the Fisher's exact test. RESULTS: Embolization caused discomfort in N=48/112 (43%) spermatic veins, comprising N=26/54 (48%) in the NBCA group and N=22/58 (38%) in the NBCA-MS group. During the week after embolization, the overall number of discomfort reports rose to N=62/106 (59%), with an increase to N=30/53 (57%) in the NBCA group and to N=32/53 (60%) in the NBCA-MS group. The number of immediate grade 2 to 4 pain reactions was N=22/112 (20%), and rose to N=37/106 (35%) after one week. No difference in discomfort during embolization and at 1 week after treatment was noted. Characteristics, severity grading, and location of discomfort were similar in both NBCA groups, regardless the time point of observation. CONCLUSION: Discomfort after glue embolization of varicocele is a common side effect, which might evolve to pain. The assumed lower inflammatory reaction on NBCA-MS was not translated in an improved tolerance.

Evaluation of clinical pharmacist recommendations in the geriatric ward of a Belgian university hospital.

OBJECTIVE: To evaluate the type, acceptance rate, and clinical relevance of clinical pharmacist recommendations at the geriatric ward of the Ghent university hospital. METHODS: The clinical pharmacist evaluated drug use during a weekly 2-hour visit for a period of 4 months and, if needed, made recommendations to the prescribing physician. The recommendations were classified according to type, acceptance by the physician, prescribed medication, and underlying drug-related problem. Appropriateness of prescribing was assessed using the Medication Appropriateness Index (MAI) before and after the recommendations were made. Two clinical pharmacologists and two clinical pharmacists independently and retrospectively evaluated the clinical relevance of the recommendations and rated their own acceptance of them. RESULTS: The clinical pharmacist recommended 304 drug therapy changes for 100 patients taking a total of 1137 drugs. The most common underlying drug-related problems concerned incorrect dose, drug-drug interaction, and adverse drug reaction, which appeared most frequently for cardiovascular drugs, drugs for the central nervous system, and drugs for the gastrointestinal tract. The most common type of recommendation concerned adapting the dose, and stopping or changing a drug. In total, 59.7% of the recommendations were accepted by the treating physician. The acceptance rate by the evaluators ranged between 92.4% and 97.0%. The mean clinical relevance of the recommendations was assessed as possibly important (53.4%), possibly low relevance (38.1%), and possibly very important (4.2%). A low interrater agreement concerning clinical relevance between the evaluators was found: kappa values ranged between 0.15 and 0.25. Summated MAI scores significantly improved after the pharmacist recommendations, with mean values decreasing from 9.3 to 6.2 (P < 0.001). CONCLUSION: In this study, the clinical pharmacist identified a high number of potential drug-related problems in older patients; however, the acceptance of the pharmacotherapy recommendations by the treating physician was lower than by a panel of evaluators. This panel, however, rated most recommendations as possibly important and as possibly having low relevance, with low interrater reliability. As the appropriateness of prescribing seemed to improve with decreased MAI scores, clinical pharmacy services may contribute to the optimization of drug therapy in older inpatients.

Azithromycin for prevention of exacerbations in severe asthma (AZISAST): a multicentre randomised double-blind placebo-controlled trial.

BACKGROUND: Patients with severe asthma are at increased risk of exacerbations and lower respiratory tract infections (LRTI). Severe asthma is heterogeneous, encompassing eosinophilic and non-eosinophilic (mainly neutrophilic) phenotypes. Patients with neutropilic airway diseases may benefit from macrolides. METHODS: We performed a randomised double-blind placebo-controlled trial in subjects with exacerbation-prone severe asthma. Subjects received low-dose azithromycin (n=55) or placebo (n=54) as add-on treatment to combination therapy of inhaled corticosteroids and long-acting ß2 agonists for 6 months. The primary outcome was the rate of severe exacerbations and LRTI requiring treatment with antibiotics during the 26-week treatment phase. Secondary efficacy outcomes included lung function and scores on the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ). RESULTS: The rate of primary endpoints (PEPs) during 6 months was not significantly different between the two treatment groups: 0.75 PEPs (95% CI 0.55 to 1.01) per subject in the azithromycin group versus 0.81 PEPs (95% CI 0.61 to 1.09) in the placebo group (p=0.682). In a predefined subgroup analysis according to the inflammatory phenotype, azithromycin was associated with a significantly lower PEP rate than placebo in subjects with non-eosinophilic severe asthma (blood eosinophilia ≤200/µl): 0.44 PEPs (95% CI 0.25 to 0.78) versus 1.03 PEPs (95% CI 0.72 to 1.48) (p=0.013). Azithromycin significantly improved the AQLQ score but there were no significant between-group differences in the ACQ score or lung function. Azithromycin was well tolerated, but was associated with increased oropharyngeal carriage of macrolide-resistant streptococci. CONCLUSIONS: Azithromycin did not reduce the rate of severe exacerbations and LRTI in patients with severe asthma. However, the significant reduction in the PEP rate in azithromycin-treated patients with non-eosinophilic severe asthma warrants further study. CLINICALTRIALS.GOV NUMBER: NCT00760838.

Measuring the nursing workload per shift in the ICU.

PURPOSE: In the intensive care unit (ICU) different strategies and workload measurement tools exist to indicate the number of nurses needed. The gathered information is always focused on manpower needed per 24 h. However, a day consists of several shifts, which may be unequal in nursing workload. The aim of this study was to evaluate if differences in nursing workload between consecutive shifts can be identified by a nursing workload measurement tool. METHODS: The nursing activities score (NAS) was registered per patient for every shift during a 4-week period in a prospective, observational research project in the surgical-pediatric ICU (SICU-PICU) and medical ICU (MICU) of an academic hospital. RESULTS: The NAS was influenced by the patient characteristics and the type of shift. Furthermore, the scores were lower during night shifts, in weekends and in MICU patients. Overall, the mean NAS per nurse per shift was 85.5 %, and the NAS per 24 h was 54.7 %. CONCLUSION: This study has shown that the nursing workload can be measured per working shift. In the ICU, the NAS differentiates the nursing workload between shifts, patients and units.

Factors associated with failure of surface-modified implants up to four years of function.

OBJECTIVES: The relative impact of innovative treatment concepts on the failure of surface-modified implants is not well understood. This retrospective study aimed to explore this using data obtained in a university postgraduate training center. MATERIAL AND METHODS: Patients treated with implants for a variety of indications over a 3-year period were included. All implants had been at least 1 year in function. Clinical records were evaluated for implant failure and in reference to implant length/diameter/location, time from tooth loss to implant placement, bone condition (native/grafted), surgical protocol (two-/one-stage), loading protocol (delayed/early/immediate), type of prosthesis (removable/fixed), surgeon's experience level (resident/trainee) and specialty (periodontist/oral surgeon). The impact of each covariate on failure was tested using the Fisher's exact test. Kaplan-Meier survival functions were constructed and Mantel-Cox log-rank tests were used to compare survival functions. To correct for possible interaction, Cox proportional Hazards regression was adopted. RESULTS: Forty-one of 1,180 (3.5%) implants were lost in 34/461 (7.4%) patients (245 ♀, 216 ♂; mean age 51, range 18-90). Factors showing significant impact on failure on the basis of univariate analyses were implant location (p = .015), surgical protocol (p = .002), loading protocol (p = .002), surgeon's experience level (p = .035) and specialty (p = .001). When controlling for other covariates, only the loading protocol had a significant influence (p = .049) with early loading more prone to failure (p = .014) when compared with delayed loading. Immediate loading and delayed loading showed comparable implant survival (p = .311). CONCLUSIONS: Implant therapy may be highly successful in a training center where inexperienced clinicians are strictly monitored and personally guided. Implant specific variables do not affect implant survival but early loading is a risk indicator for implant failure, whereas immediate loading is not.

Seizures and epilepsy in patients with a posterior circulation infarct.

Seizures occur mainly in patients with cortical infarcts in the anterior circulation. Those related to a posterior circulation infarct (POCI) are considered rare. This study investigated the characteristics of patients with seizures related to a POCI. A total of 180 consecutive patients admitted with a POCI had a 2- to 7-year follow-up; 24 of them (13.6%) developed seizures. Vascular risk factors, etiology and extension of the infarct, degree of neurologic impairment, and outcome were compared in the patients with and without seizures. Complex partial type seizure was the most common presentation. Stroke characteristics were largely the same in the patients with and without seizures. History of a previous stroke was noted in 62.5% of the seizure group and in 17.9% of the nonseizure group (P < .001). Clinical outcome was worse in the seizure group (P = .004). The relative incidence of seizures in patients with a POCI was not lower than that in the overall stroke population. The high incidence of recurrent stroke is the main risk factor for seizures in patients with a POCI. The seizures themselves are responsible for the increased dependence rate.

Efficacy and safety of two different n-butyl-2-cyanoacrylates for the embolization of varicoceles: a prospective, randomized, blinded study.

PURPOSE: This was a prospective, randomized, blinded comparative study of the efficacy and safety of two different n-butyl-2-cyanoacrylates (NBCAs) for embolization of varicoceles. METHODS: A total of 112 insufficient spermatic veins (left-sided, n=84; right-sided, n=28) that were diagnosed in 83 adult males were prospectively randomized for blinded embolization with NBCA (n=54; Histoacryl, Braun, Germany) or NBCA-MS (n=58; Glubran2, General Enterprise Marketing, Viareggio, Lucca, Italy). Handling, embolic efficacy, and safety of both NBCAs were compared according the fulfillment of a standardized embolization plan, the occlusive effect on the spermatic vein, and the sticking to the microcatheter. Statistical analysis was performed with the Mann-Whitney U test and the Fisher's exact test. RESULTS: Patients of both study arms were comparable for age and clinical indication. Spermatic vein characteristics were comparable for varicocele classification and embolization side. Both NBCAs were equally efficient in occluding the spermatic vein and blocking reflux (NBCA, n=54/54, 100% vs. NBCA-MS, n=54/57, 94.7%; P=0.244). The embolization plan could be accomplished in an equal number of veins for both groups (NBCA, n=45/54, 83.3% vs. NBCA-MS, n=41/58, 70.7%; P=0.124). Adhesiveness of the glue to the microcatheter was the same in both NBCA groups (NBCA, n=25/54, 46.3% vs. NBCA-MS, n=29/58, 50%; P=0.71). No glue-related complications were noted. CONCLUSIONS: NBCA and NBCA-MS are equally efficient and safe glues for embolization of varicoceles.

Predicting urinary creatinine excretion and its usefulness to identify incomplete 24 h urine collections.

Studies using 24 h urine collections need to incorporate ways to validate the completeness of the urine samples. Models to predict urinary creatinine excretion (UCE) have been developed for this purpose; however, information on their usefulness to identify incomplete urine collections is limited. We aimed to develop a model for predicting UCE and to assess the performance of a creatinine index using para-aminobenzoic acid (PABA) as a reference. Data were taken from the European Food Consumption Validation study comprising two non-consecutive 24 h urine collections from 600 subjects in five European countries. Data from one collection were used to build a multiple linear regression model to predict UCE, and data from the other collection were used for performance testing of a creatinine index-based strategy to identify incomplete collections. Multiple linear regression (n 458) of UCE showed a significant positive association for body weight (ß = 0·07), the interaction term sex × weight (ß = 0·09, reference women) and protein intake (ß = 0·02). A significant negative association was found for age (ß = -0·09) and sex (ß = -3·14, reference women). An index of observed-to-predicted creatinine resulted in a sensitivity to identify incomplete collections of 0·06 (95 % CI 0·01, 0·20) and 0·11 (95 % CI 0·03, 0·22) in men and women, respectively. Specificity was 0·97 (95 % CI 0·97, 0·98) in men and 0·98 (95 % CI 0·98, 0·99) in women. The present study shows that UCE can be predicted from weight, age and sex. However, the results revealed that a creatinine index based on these predictions is not sufficiently sensitive to exclude incomplete 24 h urine collections.

The use of hypnosedative drugs in a university hospital: has anything changed in 10 years?

AIM: Our goal was to investigate the use of hypnosedatives (HSs) before and during hospitalization, explore the relationship between their use and various demographic and clinical variables, and compare the results with data from a similar 2000 study with particular interest in adherence to hospital formulary guidelines. METHODS: A cross-sectional observational survey of 326 hospitalized patients recruited from ten wards of the Ghent University Hospital, Gent, Belgium, with a patient interview and by evaluating medical and nursing files. RESULTS: In 30.7% of patients, the use of a HS before admission was reported. According to the patient interview, 33.1% used a HS during hospitalization. However, according to medical and nursing files, use of HSs in the hospital was 10% higher (43.3%). In 19.4% of patients who took HSs before admission, their use was discontinued in the hospital. In 15.6% of patients who took no HS before admission, a HS was started in the hospital, according to the formulary guidelines (data from files). There was a positive correlation between HS use in the hospital and older age, longer hospitalization, not coming from home, higher number of HSs taken before hospitalization, sleeping problems emerging during hospitalization, and central nervous system (CNS) disorders. In comparison with 2000, we registered a slight decrease in HS use during hospitalization and a decrease in the number of newly started patients. CONCLUSIONS: The prevalence of HS use in our university hospital is high, mostly as a result of continuation of HSs started before admission, as there seems to be no general policy of active cessation. Compared with the survey performed 10 years ago, fewer hospitalized patients are newly started on HSs, and when this is the case, the formulary guidelines are followed.

What do standard radiography and clinical examination tell about the shoulder with cuff tear arthropathy?

BACKGROUND: This study evaluates the preoperative conventional anteroposterior radiography and clinical testing in non-operated patients with cuff tear arthropathy. It analyses the radiological findings in relation to the status of the rotator cuff and clinical status as also the clinical testing in relation to the rotator cuff quality. The aim of the study is to define the usefulness of radiography and clinical examination in cuff tear arthropathy. METHODS: This study analyses the preoperative radiological (AP-view, (Artro-)CT-scan or MRI-scan) and clinical characteristics (Constant-Murley-score plus active and passive mobility testing) and the peroperative findings in a cohort of 307 patients. These patients were part of a multicenter, retrospective, consecutive study of the French Orthopaedic Society (SOFCOT-2006). All patients had no surgical antecedents and were all treated with prosthetic shoulder surgery for a painful irreparable cuff tear arthropathy (reverse-(84%) or hemi-(8%) or double cup-bipolar prosthesis (8%)). RESULTS: A positive significancy could be found for the relationship between clinical testing and the rotator cuff quality; between acromiohumeral distance and posterior rotator cuff quality; between femoralization and posterior rotator cuff quality. CONCLUSION: A conventional antero-posterior radiograph can not provide any predictive information on the clinical status of the patient. The subscapular muscle can be well tested by the press belly test and the teres minor muscle can be well tested by the hornblower' sign and by the exorotation lag signs. The upward migration index and the presence of femoralization are good indicators for the evaluation of the posterior rotator cuff. An inferior coracoid tip positioning suggests rotator cuff disease.

Citrulline levels in a paediatric age group: does measurement on dried blood spots have additional value?

BACKGROUND: Citrulline is considered to be a marker of absorptive enterocyte mass. Citrulline levels can be measured in plasma or dried blood spot (DBS) samples. The purpose of this study is to calculate reference intervals for plasma and DBS citrulline concentrations in children and to examine the effect of age and gender. METHODS: In 151 healthy subjects ranging from 1 month to 20 years of age, plasma and DBS citrulline concentration were determined by using Liquid Chromatography-tandem Mass Spectrometry. Citrulline concentrations were examined in relation to age and gender. Reference values were calculated according to the guidelines of the International Federation of Clinical Chemistry and the National Committee on Clinical Laboratory Standards. RESULTS: No significant influence of age and gender could be discerned on plasma or DBS citrulline concentration. In children, the reference intervals for citrulline bounded by the 2.5 and 97.5 percentiles are 13.31-69.05 µmol/L and 23.70-49.04 µmol/L for plasma and DBS samples respectively. CONCLUSIONS: The reference intervals for citrulline levels in healthy children are widely dispersed. Measuring citrulline concentrations in dried blood spots delivers no additional value to plasma measurements for the calculation of reference intervals in children.

Extracorporeally irradiated autografts for the treatment of bone tumours: tips and tricks.

We retrospectively reviewed 107 patients with 108 malignant or locally aggressive bone tumours treated between 1978 and 2009 by extracorporeal irradiation with 300 Gy to eradicate the tumour, and reimplantation of the bone as an orthotopic autograft. Patient subgroups were defined according to resection type. We describe the local recurrence rate, the graft infection rate and the factors affecting graft healing and graft survival. No local recurrences were detected in the irradiated grafts. At five-year follow-up, graft healing had occurred in 64% of patients, providing a stable and lasting reconstruction. For various reasons, 11% of grafts were removed, although no single factor was predictive of failure. All patient subgroups had comparable results. Early infection predicted the development of pseudarthrosis. Pelvic reconstructions had a worse graft survival. Rigid fixation and bridging of the graft appeared to be important technical points.

Radiographic analysis of extracorporeally irradiated autografts.

OBJECTIVE: To analyse the long-term radiographic findings of intercalary, pure osteoarticular, and composite bone grafts in patients with primary bone sarcoma who were treated by reimplantation of the bone as an orthotopic autograft. MATERIALS AND METHODS: For this observational clinical study, 107 patients who presented with 108 malignant or locally aggressive benign bone tumours were treated by resection, extracorporeal irradiation (300 Gy), and reimplantation and fixation of the autograft. Bone healing features were evaluated with the International Society of Limb Salvage (ISOLS) graft evaluation method, which assesses fusion, resorption, fracture, graft shortening, fixation, subluxation, joint narrowing, and subchondral bone. A description of normal and abnormal healing patterns and complications comprised the secondary endpoint. RESULTS: Seventy-seven patients with complete radiographic data were selected for review. The mean ISOLS score was 78.2% (range 25.0-100%, median 79.2%). Three patient subgroups were created: intercalary graft, pure osteoarticular graft, and composite reconstruction consisting of an intercalary graft augmented with a prosthesis; the mean ISOLS scores were 81.3%, 70.7%, and 77.4%, respectively. Each item was scored individually, and no significant difference was observed (P = 0.225). CONCLUSION: This reconstruction technique is valid for the three methods described; bone stock is retained and, once the graft has healed, it behaves as normal bone. Close radiographic follow-up detects complications early, allowing timely interventions if necessary.

Introducing telemonitoring for diabetic patients: development of a telemonitoring 'Health Effect and Readiness' Questionnaire.

PURPOSE: Till now no validated instrument exists to measure the readiness and attitude of diabetic patients towards the use of telemonitoring. The purpose of the described study was to develop a Telemonitoring Attitude and Readiness Questionnaire and to check its validity and reliability. METHODS: After performing in-depth interviews in two separate sessions, the Telemonitoring Attitude and Readiness Questionnaire was completed by a convenience sample of 138 patients with type 1 and type 2 diabetes to determine internal consistency. Test-retest reliability was further evaluated with a subsample of 21 patients. RESULTS: Analysis supports the validity and reliability of the 13-item Telemonitoring Health Effect and Readiness Questionnaire (THERQ) with three subscales: Communication with peers or during holidays with a professional (Cronbach's alpha=0.84), telemonitoring health effect (Cronbach's alpha=0.87), and communication with a professional from home (Cronbach's alpha=0.88). Test-retest reliability is satisfactory (intraclass correlation coefficients between 0.58 and 0.92). CONCLUSIONS: The results of this study provide preliminary evidence that the Telemonitoring Health Effect and Readiness Questionnaire is a valid and reliable instrument to measure the readiness and subjective feelings of health effect towards the use of telemonitoring. The THERQ could be used before the implementation of telemonitoring to check if diabetic patients are interested in the use of it but it could also be used in (randomized) controlled trials as the questions are put in such a way that also patients not (yet) using telemonitoring can answer the questions.

Predictability of cerebral palsy and its characteristics through neonatal cranial ultrasound in a high-risk NICU population.

The aim of the study is to evaluate the predictive value of various types of brain injury detected by ultrasound in the neonatal period for the occurrence of cerebral palsy and its characteristics in a large cohort of high-risk infants. Thousand twenty-one consecutively NICU-admitted high-risk infants were assessed up to the corrected age of at least 2 years. Cerebral palsy (CP) was categorised into spastic or non-spastic, bilateral or unilateral and mild, moderate or severe CP. Different types of brain injury were identified by serial cranial ultrasound (US) during the NICU stay: white matter disease (WMD), haemorrhage, cerebral infarction, deep grey matter and parasagittal cerebral injury. There is a significant overall association between different types of brain injury and gestational age. Only 4% of the children with normal US develop CP. In the presence of any abnormal US image, the likeliness to develop CP is at least seven times higher. Within the group of infants with WMD and haemorrhage, the degree of brain involvement has a clear impact on the occurrence of CP. Concerning the characteristics of CP, deep grey matter lesion predict non-spastic CP versus spastic CP (OR = 31, P < 0.001). Cerebral infarction and haemorrhage grade IV are strong predictors of unilateral spastic CP versus bilateral spastic CP (OR = 49 and 24, respectively, P < 0.001). Deep grey matter lesion is a significant predictor for severe versus mild and moderate CP (OR = 6). In conclusion, neonatal cranial US is a useful tool in predicting CP and its characteristics.

Medication administration in nursing homes: pharmacists' contribution to error prevention.

BACKGROUND: The elderly use a large number of medications, which exposes them to an increased risk for medication-related errors, especially in nursing homes. OBJECTIVES: The aim of this study was to investigate the impact of an educational session addressing good medication administration practices on the medication administration error rate in 2 nursing homes. METHOD: A before-after study was performed, comparing outcome measurements 1 month before and 1 month after implementation of a formal training session on "good medication administration principles." Medication administration errors were detected using a direct observation method. Two experts (a geriatrician and a clinical pharmacist) scored the clinical relevance of these errors. The study was carried out between March 2007 and June 2007. RESULTS: In both nursing homes, the overall error rate (preparation errors and administration errors) decreased after the intervention. This decrease was significant both in nursing home 1 (P < .001) and nursing home 2 (P = .049). None of the observed errors was rated highly likely to cause harm according to the experts. CONCLUSION: An educational session about good medication administration practices provided by a pharmacist is a very simple way to decrease medication administration error rates and to raise awareness on the possible clinical significance of the errors.