Using multimedia to enhance the consent process for bunion correction surgery.

BACKGROUND: Obtaining informed consent from patients considering bunion surgery can be challenging. This study assessed the efficacy of a multimedia technology as an adjunct to the informed consent process. METHODS: A prospective, cohort study was conducted involving 55 patients (7 males, 48 females) who underwent a standardized verbal discussion regarding bunion correction surgery followed by completion of a knowledge questionnaire. A multimedia educational program was then administered and the knowledge questionnaire repeated. Additional supplementary questions were then given regarding satisfaction with the multimedia program. RESULTS: Patients answered 74% questions correctly before the multimedia module compared with 94% after it (P < 0.0001). Patients rated the ease of understanding and the amount of information provided by the module highly. Eighty-four percent of patients considered that the multimedia tool performed as well as the treating surgeon. CONCLUSION: Multimedia technology is useful in enhancing patient knowledge regarding bunion surgery for the purposes of obtaining informed consent.

Outcome of porous tantalum acetabular components for Paprosky type 3 and 4 acetabular defects.

Porous tantalum acetabular implants provide a potential solution for dealing with significant acetabular bone loss. This study reviews 24 acetabular revisions using tantalum implants for Paprosky type 3 and 4 defects. The mean Harris Hip Score improved from 35 ± 19 (range, 4-71) to 88 ± 14 (range, 41-100), p < 0.0001. Postoperative radiographs showed radiolucent lines in 14 hips with a mean width of 1.3 ± 1.0 mm (range, 0.27-4.37 mm). No gaps enlarged and 71% of them disappeared at a mean of 13 ± 10 months (range, 3-29 months). At a mean follow-up of 37 ± 14 months (range, 24-66 months), 22 reconstructions showed radiograpic evidence of osseointegration (92%). The two failures were secondary to septic loosening. When dealing with severe acetabular bone loss, porous tantalum acetabular components show promising short-term results.

Transcutaneous carbon dioxide monitoring and capnography during pediatric polysomnography.

INTRODUCTION: Transcutaneous monitoring and capnography are 2 surrogate methods of measuring arterial carbon dioxide levels employed by pediatric sleep laboratories. Both techniques are noninvasive, validated, and quantitative indirect predictors of arterial carbon dioxide level, and both have been widely adopted for use during pediatric and adult polysomnography (PSG). We hypothesized that there would be close agreement between the two techniques when compared in a pediatric population. METHODS: Children referred for diagnostic polysomnography to the Pediatric Sleep Laboratory at the Alberta Children's Hospital from June 2000 to October 2003 were included. All subjects underwent an overnight computerized PSG as per American Thoracic Society standards, including both transcutaneous and end-tidal monitoring. A registered PSG technician manually scored studies and eliminated all CO2 data that was not interpretable. Total "uninterpretable data" time was calculated for both channels. Statistical analysis of the level of agreement between transcutaneous and end-tidal signals was performed using a Bland-Altman analysis. RESULTS: The PSG studies of 609 children (363 males), mean age 7.9 +/- 4.6 years (range 0.1-18.4), were reviewed. On average, interpretable data was available for 61.8% +/- 35.1% and 71.5% +/- 25.2 % of total recording time from the end-tidal and transcutaneous channels respectively. The maximum and mean CO2 measurements obtained by both devices showed close agreement with a mean difference of 0.1 +/- 5.4 mm Hg and 0.6 +/- 3.9 mm Hg respectively. CONCLUSION: Transcutaneous and end-tidal carbon dioxide monitoring during polysomnography are well tolerated and provide interpretable and comparable results in the majority of children.

Detecting environmental change in eastern Australia: rangeland health in the semi-arid woodlands.

We examined changes in rangeland health in the semi-arid woodlands of eastern Australia at fixed sites between 1989 and 1999. Over the 11-year period there were significant declines in the quality of the vegetation, and changes in plant species were driven largely by seasonality, and to a lesser extent, amount of rainfall. Three indices of rangelands health (composition, function and stability) developed using site-based vegetation and landscape data, indicated that the majority of sites had intermediate values of the three indices, and few sites had either very low or very high values. The indices of composition and function were strongly correlated with the subjective ratings applied to each site at each measurement period. The results of this study highlight the difficulty of detecting change over extensive areas of rangeland, and of separating management-induced effects from climatic effects in an environment which experiences wide spatial and temporal variation in rainfall.

Orthodontic/restorative interface.

There have been many advances in orthodontic and restorative procedures. These can be combined to provide a very powerful tool in providing the optimum results. This article describes when a combined approach would be appropriate and discusses how the various problems are overcome.

Molecular diagnosis of Borrelia burgdorferi infection (Lyme disease).

In spite of significant advances in immunologically based testing, accurate diagnosis of Lyme borreliosis remains problematic. To address this issue, a DNA amplification-based diagnostic test was developed utilizing the polymerase chain reaction (PCR) and oligonucleotide primers specific for the OspA and OspB genes of Borrelia burgdorferi. In this approach, a relatively large DNA fragment is amplified with an outer set of primers, and a "nested" internal sequence of the PCR product subsequently reamplified with an inner set of primers. This nested approach coupled with simple differential centrifugation allowed specific detection of as few as four B. burgdorferi organisms mixed in 2 ml of blood. This methodology was utilized on patients' samples, and it allowed detection of B. burgdorferi in the peripheral blood and urine of several individuals with clinical evidence of Lyme borreliosis. PCR became negative and symptoms improved following antibiotic therapy of treated individuals. These studies suggest that direct detection of Borrelia in infected individuals can aid in diagnosis and evaluation of therapy for Lyme borreliosis.

Food Aversion Learning by the Hermit Crab Pagurus granosimanus.

The common intertidal hermit crab Pagurus granosimanus learns in one or two trials to reject an attractive, novel food (beef) when illness is induced by lithium chloride injected one hour after the animal accepts and eats the beef. Crabs fed a familiar food (fish) before lithium chloride injection do not learn to avoid the fish. Nor do they learn to reject beef when injected with a sodium chloride solution, or when punctured with a hypodermic needle one hour after their first and second beef meals. Because many crustaceans are scavengers and generalist feeders, they must commonly encounter a wide variety of toxic foods. Quickly acquired and long-lasting aversion to a new food eaten a few hours before the onset of a serious physiological upset could cause these animals to avoid such hazardous foods in the future. Food aversion learning has never before been reported in a crustacean.

The immediate or delayed replacement of teeth by permucosal intra-osseous implants: the Tübingen implant system. Part 2: Surgical and restorative techniques.

The previous paper emphasised the importance of case selection in determining success in the use of the Tübingen implant system. Adherence to strict clinical techniques has an equally important influence on implant success and failure. This paper describes the surgical and restorative techniques involved in the use of the Tübingen implant and comments on the authors' initial experiences with this system.

The immediate or delayed replacement of teeth by permucosal intra-osseous implants: the Tübingen implant system. Part 1. Implant design, rationale for use and pre-operative assessment.

No single implant system is applicable to all clinical problems which may be treated with implants. Clinicians who wish to develop expertise in the field of dental implantology should decide which clinical situations they wish to treat with implants and then receive an appropriate level of instruction in the use of systems which have been shown, in refereed literature, to be successful in the treatment of such problems. The Tübingen implant system has been in clinical use for more than 13 years, following preliminary basic research and animal studies, and is supported by an extensive literature. It is applicable primarily to the immediate or delayed replacement of individual teeth which are subsequently to be restored with a post crown. It may also be used in other situations, such as in combination with bridge restorations. This is the first of two papers which describe in detail the range of applications, patient selection and assessment, and the surgical and restorative techniques involved in its use.

Production of aflatoxins B1 and G1 by Aspergillus flavus in a semisynthetic medium.

Isolates of Aspergillus flavus produced 0.2 to 63 mg of aflatoxins B(1) and G(1) per 100 ml in a nutrient solution consisting of 20% sucrose and 2% yeast extract. Various factors influencing the fermentation were studied. The maximal amount of toxin was produced by ATCC culture 15548 in 1-liter flasks containing 100 ml of medium incubated as stationary cultures for 6 days at 25 C.