The development and validation of a psychological questionnaire for patients undergoing orthognathic treatment.

OBJECTIVES: To develop a questionnaire to assess the psychosocial aspects which orthognathic patients considered important regarding their dento-facial deformity. SETTING AND SAMPLE POPULATION: A multicentre, prospective, questionnaire development and validation study based in the UK. MATERIAL AND METHODS: Questionnaire development involved item (question) selection through literature review, consultation and feedback from a questionnaire development group and semi-structured interviews. A 'final' questionnaire was tested on a cross-sectional sample of 110 pre-operative and 74 post-operative orthognathic patients and a longitudinal sample of 23 orthognathic patients. Validity was tested using Rasch analysis. RESULTS: Reliability for the Hospital Anxiety and Depression Scale (HADS) section was unsatisfactory (ICC = 0.232-0.829, Cronbach alpha = 0.625-0.670), but for the well- being (ICC = 0.857, Cronbach alpha = 0.827-0.895) and expectations (ICC = 0.861, Cronbach alpha = 0.804-0.882) sections were satisfactory. The well-being section was the only section found to be valid for the pre-and post-operative samples. Responsiveness was satisfactory for the well-being scale (p = 0.001). CONCLUSIONS: A new condition-specific orthognathic questionnaire has been developed which has been shown to be reliable, valid and responsive for the well-being scale. The HADS, as tested by Rasch analysis, was found not to be valid for this orthognathic population.

Patient and parent satisfaction following autotransplantation and associated orthodontic treatment delivered by an interdisciplinary team.

AIM: To survey patient and parent satisfaction with premolar transplantation and the associated orthodontic treatment. METHOD: A postal service evaluation questionnaire was used to survey patient and parent satisfaction for children who had completed treatment involving premolar transplantation and the associated orthodontics. Patients and parents each completed separate questionnaires. For some questions a Likert scale from 1 to 10 was used. RESULT: Questionnaires were sent to 41 patients and their parents who had premolar transplants and orthodontic treatment. Following repeat mailing of the questionnaires: 20 of the patient and 25 parent questionnaires were completed and returned. Patients and parents felt there was a large improvement in dental appearance (median scores 8 and 10) and were highly satisfied with the final appearance (median scores 8 and 9). Both groups felt that treatment transition between departments was very good (median scores 9 and 9). Patients experienced moderate discomfort during their premolar transplant surgery and during their orthodontic treatment (scores 6 and 5, respectively). Most patients and parents would recommend this type of treatment (92 and 88%, respectively). CONCLUSION: Overall, patients and parents report high levels of satisfaction with all aspects of their premolar transplant and their associated orthodontic treatment.

Pharmacokinetics and systemic effects of inhaled fluticasone propionate in chronic obstructive pulmonary disease.

AIMS: We have previously shown that the systemic exposure to inhaled fluticasone propionate (FP) is reduced in asthmatics compared with healthy subjects. We have now compared its pharmacokinetics in patients suffering from chronic obstructive pulmonary disease (COPD, n = 10) and matched healthy subjects (n = 13). METHODS: A double-blind, randomized, cross-over study design was used. Plasma FP and serum cortisol were measured for 12 h after subjects received hydrofluoroalkane FP 1000 microg day-1 inhaled (via an MDI and spacer) for 7 days and following a single 1000- microg intravenous dose. RESULTS: The pharmacokinetics differed in the two groups. After inhalation, geometric least square means were significantly lower in the COPD group for the plasma AUC (1961 vs 2996 pg ml-1 h-1 for COPD and controls, respectively; P = 0.03) and the Cmax (235 vs 421 pg ml-1 for COPD and controls, respectively; P = 0.03). Suppression of serum cortisol concentration over 12 h was greater in healthy controls. Weighted mean serum cortisol concentration (nmol l-1) in healthy subjects and COPD was 93 and 170, respectively (P = 0.03). The intravenous pharmacokinetic parameters for FP were comparable in the two groups, resulting in similar suppression of serum cortisol. CONCLUSIONS: We conclude that the altered pharmacokinetics of inhaled fluticasone propionate in COPD caused less hypothalamic-pituitary-adrenal suppression than in healthy controls. This is further evidence that the systemic effects of inhaled corticosteroids should be assessed in patients and not healthy subjects.

Synthetic pillows contain higher levels of cat and dog allergen than feather pillows.

The use of non-feather pillows has increased over the last few decades. Recently, we found significantly higher levels of dust mite allergens in synthetic pillows than in feather ones. This study investigated the levels of pet allergens in feather and synthetic pillows. Dust samples were collected from 14 pairs of pillows (consisting of one synthetic fibre-filled and one feather-filled). Each pair of pillows had been on the same bed for at least 2 years. The pillows were vacuumed for 1 min on each side through a 355-microm diameter mesh onto a 5-microm vinyl filter, producing a sample of fine dust. Samples were extracted, and cat (Fel d 1) and dog (Can f 1) allergens determined using monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA). Results were expressed both as total amount of allergen recovered and concentration of allergen per unit weight (ng/g). Total levels of pet allergens were significantly higher in the synthetic pillows (Fel d 1: 6.7-fold difference [95% CI 1.5-29.7], p=0.01; Can f 1: 8-fold difference [95% CI 1.6-39.5], p=0.01). Similarly, when the results were expressed as ng/g, synthetic pillows contained significantly more allergens than feather pillows (Fel d 1: 3.7-fold difference [95% CI 1.3-10.1], p=0.01); Can f 1: 4.4-fold difference [95% CI 1.5-13.2], p=0.01). We have therefore demonstrated that synthetic pillows contain significantly more pet allergens than feather pillows, supporting the view that tightly woven encasements surrounding feather pillows act as a barrier for allergens.

Pharmacokinetics of phenobarbital in dogs after multiple oral administration.

Sodium phenobarbital (PHB) was administered orally as tablets 3 times a day to 6 healthy mature dogs of mixed breeding for 5 days at a dose of 2 mg/kg of body weight. On the 6th day, PHB was administered at 9 AM and venous blood samples were collected at 0, 1, 2, 3, 4, 6, 8, 10, 12, 14, 23, 35, 47, 59, 71, 83, 95, 107, 119, and 131 hours. Additional PHB was not given on day 6. Drug serum concentrations were described by a 1-compartment model with first-order absorption and elimination with fitted correlation coefficients of 0.991 +/- 0.007 (mean +/- SD). The observed PHB half-lives were between 37.3 and 74.6 hours with a mean of 53.0 +/- 15 hours. The calculated volume of distribution (Vd/F) was 743.6 +/- 69.8 ml/kg, and the total body clearance (ClT/F) was 0.173 +/- 0.053 ml/min/ kg. The absorption half-life was 1.27 +/- 0.21 hours. Based on the observed biological half-life after 5 days of dosing, approximately 11 days (8 to 15.5 days) of multiple dosing would be required to achieve steady-state serum concentrations. From average values, predicted maintenance doses of 1.8 mg/kg of body weight 3 times a day or 5.5 mg/kg once daily would be required to achieve average serum concentrations of 20 microg/ml. Due to intersubject variations in ClT/F, these doses would result in subtherapeutic or toxic serum concentrations in 2 of the 6 dogs. Further disposition and dosing regimen studies need to be performed during chronic PHB administration in dogs to evaluate autoinduction and intersubject differences in disposition kinetics.