OMFS training revisited.
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Clinical Competence↗
Biomedical subjects
M Cameron
Publications and source records attributed to M Cameron.
Superficial heat or cold for low back pain.
BACKGROUND: Heat and cold are commonly utilised in the treatment of low-back pain by both health care professionals and people with low-back pain. OBJECTIVES: To assess the effects of superficial heat and cold therapy for low-back pain in adults. SEARCH STRATEGY: We searched the Cochrane Back Review Group Specialised register, the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to October 2005), EMBASE (1980 to October 2005) and other relevant databases. SELECTION CRITERIA: We included randomised controlled trials and non-randomised controlled trials that examined superficial heat or cold therapies in people with low-back pain. DATA COLLECTION AND ANALYSIS: Two authors independently assessed methodological quality and extracted data, using the criteria recommended by the Cochrane Back Review Group. MAIN RESULTS: Nine trials involving 1117 participants were included. In two trials of 258 participants with a mix of acute and sub-acute low-back pain, heat wrap therapy significantly reduced pain after five days (weighted mean difference (WMD) 1.06, 95% confidence interval (CI) 0.68 to 1.45, scale range 0 to 5) compared to oral placebo. One trial of 90 participants with acute low-back pain found that a heated blanket significantly decreased acute low-back pain immediately after application (WMD -32.20, 95%CI -38.69 to -25.71, scale range 0 to 100). One trial of 100 participants with a mix of acute and sub-acute low-back pain examined the additional effects of adding exercise to heat wrap, and found that it reduced pain after seven days. There is insufficient evidence to evaluate the effects of cold for low-back pain, and conflicting evidence for any differences between heat and cold for low-back pain. AUTHORS' CONCLUSIONS: The evidence base to support the common practice of superficial heat and cold for low back pain is limited and there is a need for future higher-quality randomised controlled trials. There is moderate evidence in a small number of trials that heat wrap therapy provides a small short-term reduction in pain and disability in a population with a mix of acute and sub-acute low-back pain, and that the addition of exercise further reduces pain and improves function. The evidence for the application of cold treatment to low-back pain is even more limited, with only three poor quality studies located. No conclusions can be drawn about the use of cold for low-back pain. There is conflicting evidence to determine the differences between heat and cold for low-back pain.
Adult↗
Snookered! Facial infection secondary to occult foreign body.
A case is presented of a man suffering from a severe purulent temporofacial infection that was secondary to an occult foreign body. The patient had been impaled on a 13 cm section of snooker cue and was entirely unaware of its presence despite the size. The management of this case is presented and discussed.
Facial Injuries↗
Synchronous reconstruction of the exenterated orbit with a pericranial flap, skin graft and osseointegrated implants.
Reconstruction of the exenterated orbit remains a surgical challenge. Here, the authors present a case in which orbital exenteration was performed for an extensive, infiltrating medial canthal basal cell carcinoma; the resulting defect was reconstructed with osseointegrated implants and a pericranial flap onto which a split thickness skin graft was placed. The second stage of the aesthetic rehabilitation of this patient (placement of the transcutaneous abutments) was completed under local anaesthetic 16 weeks later. Subsequently, the patient was fitted with an oculoplastic prosthesis four weeks later. The above technique accelerates the prosthetic rehabilitation of the patient by performing the primary reconstructive procedures simultaneously with the exenteration and by removing the need for secondary surgical procedures under general anaesthetics. The whole process from orbital exenteration to the fitting of an ocular prosthesis was completed in just five months.
Aged↗
Bilateral dislocation of temperomandibular joints in a child: easily missed with the dummy in.
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Diagnostic Errors↗
Valproic acid for agitation in dementia.
BACKGROUND: Agitation affects up to 70% of older people with dementia. Valproic acid has been used for the past 10 years to control agitation in dementia, but no systematic review of the effectiveness of this drug has been published to date. The current study examines three randomized, placebo-controlled trials of the effect of valproic acid on older people with dementia who were agitated. OBJECTIVES: To determine whether evidence supports the use of valproic acid in the treatment of agitation of people with dementia. SEARCH STRATEGY: Trials were identified from a last updated search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 10 July 2003 using the terms ("agitat*" or "distur*" or "behavi*" or "aggress*") and "valproic" or "valproate" or "divalpro*." This Register contains articles from all major health care databases and many ongoing trials databases and is regularly updated. The reviewers contacted the authors of publications and drug companies manufacturing valproic acid for additional information. SELECTION CRITERIA: Randomized, placebo-controlled trials with concealed allocation where agitation and dementia of participants were assessed DATA COLLECTION AND ANALYSIS: 1. Two reviewers extracted data from published trials. 2. Odds ratios of average differences were calculated. 3. Only "intention to treat" analyses were included. 4. Analysis compared participants treated with valproic acid with controls. MAIN RESULTS: Meta-analysis of the pooled results of the included trials could not be performed because of the following problems. In Porsteinsson 2001, although the physicians having direct responsibility for patient care were blinded, a non-blinded physician, who had no direct contact with these physicians, adjusted divalproex sodium dosage on the basis of reports from blinded raters. Therefore, because the physician who controlled therapy knew which patients were receiving divalproex, the trial did not satisfy the criterion of concealed allocation. In Tariot 2001, 54% of the treated patients dropped out compared with 29% of control patients. Of all treated patients, 22% dropped out because of adverse effects, and the study had to be discontinued prematurely. The third trial (Sival 2002) had a cross-over design. No results from the first phase of the study were available, and although the statistical section stated, "the t-test for independent samples is used to analyze the two-period cross-over trial", because the samples were not independent - they are the same patients in the treatment and placebo groups - a question must be raised about the correctness of the analyses. The type of valproate used in the trials varied - one used short-acting sodium valproate, one long-acting divalproex sodium, and the third early-onset acting divalproex sodium. Average doses differed (480mg/d - 1000mg/d), as did duration of therapy (3 wks - 6 wks), and ways of evaluating patients and their response to therapy. A limited meta-analysis, pooling the results concerning adverse effects (Porsteinsson 2001, Tariot 2001) revealed the following: Sedation occurred more frequently in patients treated with valproic acid than in controls Urinary tract infection was more common among patients treated with valproic acid than controls Because of differences in identifying adverse effects it was not possible to pool other observations concerning adverse effects between the two studies that were examined. REVIEWERS' CONCLUSIONS: The trials reviewed should be regarded as preliminary. Individual reports suggest that low dose sodium valproate is ineffective in treating agitation among demented patients, and that high dose divalproex sodium is associated with an unacceptable rate of adverse effects. More research on the use of valproate preparations for agitation of people with dementia is needed. On the basis of current evidence, valproate preparations cannot be recommended for the treatment of agitation in dementia.
Aged↗
Respite care for people with dementia and their carers.
BACKGROUND: Caring for someone with dementia can be emotionally and physically demanding. Respite care is any intervention designed to give rest or relief to caregivers. It is not clear what positive and negative effects the provision of respite care may have on people with dementia and their caregivers. OBJECTIVES: To assess the effects of respite care for people with dementia and their caregivers, in particular the effect of respite care on rates of institutionalization. SEARCH STRATEGY: The trials were identified from a last updated search of the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 2 July 2003 using the terms respite* and "day care". This Register contains up to date records from all major health care databases and many ongoing trial databases. SELECTION CRITERIA: Randomized controlled trials comparing respite care with a control intervention for people with dementia. DATA COLLECTION AND ANALYSIS: Both reviewers carried out study selection independently and reached a consensus through discussion. Data was extracted by a single reviewer. The reviewers contacted all investigators for methodological details not reported in the text and for additional data. MAIN RESULTS: Three trials were included in the review. They were different in many ways including intervention, duration and outcomes so pooling of data was not possible. Re-analysis of outcomes using data from the published studies found no significant effects of respite care on any variable. REVIEWERS' CONCLUSIONS: Current evidence does not demonstrate any benefits or adverse effects from the use of respite care for people with dementia or their caregivers. These results should be treated with caution, however, as they may reflect the lack of high quality research in this area rather than an actual lack of benefit. Given the frequency with which respite care is advocated and provided, well-designed trials in this area are needed.
Aged↗
The accuracy of MRI in predicting recovery and recurrence of acute grade one hamstring muscle strains within the same season in Australian Rules football players.
The purpose of this study was to use MRI to classify acute grade one hamstring muscle strains in Australian Rules footballers to determine if it was accurate in predicting the recovery time for each injury and also able to predict those that would recur within the same season. A prospective study was performed over five years at a professional Australian Football League club. Thirty-one acute grade one hamstring injuries underwent MRI examination within 24-72 hours following the injury. Each injury underwent the same rehabilitation programme. The rehabilitation interval (RI) was the time in days for the player to resume full team training. Fourteen (45%) of the injuries were normal on MRI. Seventeen (55%) were abnormal with a hyperintense T2 lesion on the axial fat suppressed views. The MRI negative group had a significantly faster RI (6.6 days) compared with the MRI positive group (20.2 days). Both the length and cross sectional area (CSA) of the MRI positive lesions were measured. The length of the lesion had a stronger correlation coefficient with the RI (0.84) than did the CSA (0.76). Six of the 17 MRI positive strains recurred with no correlation found between the lesion's length or CSA, or the RI. None of the 14 MRI negative injuries recurred. The study confirms that MRI can aid in the investigation of acute grade one hamstring muscle strains in predicting recovery time. However the size of the initial strain or the RI do not seem to be reliable indicators in predicting those strains that might recur.
Adolescent↗
Transcutaneous electrical nerve stimulation (TENS) for dementia.
BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) is the application of an electrical current through electrodes attached to the skin. The commonest clinical application of TENS is pain control. TENS is also used occasionally for the treatment of a range of neurological and psychiatric conditions including drug and alcohol dependence, headaches, and depression. TENS is rarely used for the treatment of dementia. However, since the early 1990s a number of studies carried out by a group in the Netherlands, and one study carried out by a group in Japan, suggest that TENS applied to the back or head may improve cognition and behaviour in patients with Alzheimer's disease or multi-infarct dementia. It was claimed that applying TENS could benefit patients with dementia by altering the activity of various neurotransmitters, or by increasing brain activity and thereby retarding neural degeneration and stimulating regenerative processes. It is claimed that application of TENS to the head may also alleviate the sleep disorders associated with dementia. OBJECTIVES: The aim of this review is to determine the effectiveness and safety of transcutaneous electrical nerve stimulation (TENS) in the treatment of dementia. Secondary objectives of this review are to determine whether any effect of treatment of dementia with TENS is influenced by any treatment parameters or patient features, including: the duration of treatment, electrical waveform, current amplitude, pulse duration and frequency and the patient's type or severity of cognitive impairment. SEARCH STRATEGY: The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 10 December 2002 using the terms TENS, transcutaneous, "transcutaneous electrical nerve stimulation", and "electric stimulation". The CDCIG Specialized Register contains records from all major health care databases and many ongoing trials databases and is regularly updated. SELECTION CRITERIA: All RCTs in which TENS was used as an intervention for people with dementia were included in this review. This included peripherally applied transcutaneous electrical stimulation as well as transcutaneous electrical stimulation applied to the head (also known as cranial electrical stimulation (CES)). DATA COLLECTION AND ANALYSIS: All RCTs that fulfilled the inclusion criteria for the review and for which sufficient data were available were included in this meta-analysis. Two reviewers extracted the data from the included trials. All except one of the included trials used similar outcome measures. Data of the same outcome measures were combined for analysis. MAIN RESULTS: Eight trials were included in the review but only 3 trials could be included in the meta-analysis. Sufficient data to include the other trials in the meta-analysis could not be obtained. From this limited analysis it appears that TENS produced a statistically significant improvement directly after treatment in: delayed recall of 8 words in one trial, face recognition in two trials and motivation in one trial however, no effect of TENS was found on any of the many other neuropsychological and behavioural measures evaluated either directly after TENS treatment or 6 weeks after treatment was completed. REVIEWER'S CONCLUSIONS: Although a number of studies suggest that TENS may produce short lived improvements in some neuropsychological or behavioural aspects of dementia, the limited presentation and availability of data from these studies does not allow definite conclusions on the possible benefits of this intervention. Since most of the currently published studies are well designed, although the numbers of subjects in each study is small, analysis of the complete original data from these and/or future studies may allow more definitive conclusions to be drawn.
Aged↗
Kicking footedness and movement discrimination by elite Australian Rules footballers.
Kicking a football accurately with a certain velocity over a desired distance is dependent upon the speed of the kicking foot and the quality of contact between the foot and ball. Control of the swinging lower leg is critical to these factors and the overall performance of the kick, and this was assessed in 20 Australian Football League players. Assessment of movement extent discrimination of the swinging leg was made while standing on the other leg. An automated device accurately set a stop plate to five different positions and each subject was asked to swing the leg to the plate, and make a non-visual judgment of the movement extent. Forty forward and forty backward swings of each leg were assessed, and based on a subject's responses, non-parametric signal detection analysis resulted in a movement extent discrimination score. For left leg performance, coach ratings of overall kicking ability were correlated with movement discrimination ability. Left-foot kickers (0.83) had a higher movement discrimination score than right-foot kickers (0.77), and had a significantly higher score on their dominant side, whereas right-footers had no left-right side difference. Rating of kicking ability by coaches also reflected this difference between the dominant leg performance of left- and right-footers. These data showed left-foot kickers to have higher movement discrimination ability with their dominant leg, and this may be related to their on-field kicking ability.
Adult↗
A conundrum from antenatal testing.
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Abortion, Induced↗
Contractures in the post-stroke wrist: a pilot study of its time course of development and its association with upper limb recovery.
BACKGROUND: Contractures are common in a stroke population, yet there is little information on the time course of development. OBJECTIVES: Investigate quantitatively changes associated with contracture formation in an acute stroke population. STUDY DESIGN: Longitudinal study on 22 subjects who were 2-4 weeks post stroke. OUTCOME MEASURES: Contractures were assessed by quantifying the resting posture, resistance to passive movement and passive range of movement. Upper limb function was measured using the Action Research Arm Test and the Nine-Hole Peg Test. Active range of extension, wrist extension strength (isometric), grip strength and neglect were also measured. REPEATED MEASURES: Following an initial assessment, repeated measurements were taken at 4, 8, 20 and 32 weeks after recruitment. RESULTS: Two distinct subgroups, one capable of some functional movement (F group; 8 subjects) and another which was not (NF group; 14 subjects), were identified at the start of the study. The NF group showed changes associated with contracture formation at the wrist, i.e., reduction in the passive range of movement, an increase in resistance to passive movement and a worsening of the flexion posture. Changes were observed from the time of recruitment even though neglect improved. The F group showed improvements in upper limb function and there was no evidence to support contracture formation. CONCLUSIONS: Subjects most prone to contracture formation were those who showed no signs of early functional recovery (2-4 weeks after the stroke). Changes consistent with adaptive shortening were seen from week 4 of the study period.
Adult↗
Effects of dietary tallow level on performance of Alpine does in early lactation.
Sixty Alpine does (initial BW 47+/-1.3kg) were used to determine effects of dietary inclusion of different levels of partially hydrogenated tallow on performance in early lactation (weeks 3-11). Treatments entailed a 30% concentrate, negative control (NC) diet and five diets higher in concentrate (42-46%) with 0, 1.5, 3.0, 4.5 or 6.0% DM of partially hydrogenated tallow (0T, 1.5T, 3.0T, 4.5T and 6.0T, respectively). DM intake was 1.54kg per day for the NC and 1.86, 1.80, 1.99, 2.17 and 1.96kg per day for the five tallow treatments, respectively, BW was similar among treatments and increased as the trial progressed (47.4, 48.4, 49.8, 50.4, 50.8 and 51.3kg at weeks 3, 5, 7, 9, 11 and 13, respectively). Milk yield was lower (P<0.05) for NC (2.61kg per day) compared with the mean of the other diets and changed quadratically (P<0.05) as tallow level increased (2.85, 3.08, 3.14, 3.21 and 2.69kg per day for the five tallow treatments, respectively). Milk fat concentration was lower (P<0.05) for NC (2.94%) than for the mean of other diets and increased linearly (P<0.05) with increasing tallow level (3.00, 3.17, 3.34, 3.48 and 3.58%) whereas, milk protein concentration was not affected by level of tallow (2.72, 2.80, 2.93, 2.85, 2.90 and 2.90% for NC, and the five tallow treatments, respectively). The estimated NE(l):4% fat-corrected milk yield ratio was 0.93Mcal/kg for NC and 1.30, 1.11, 1.21, 1.37 and 1.44Mcal/kg for the five tallow treatments, respectively. The results indicated that in Alpine does, milk yield in early lactation increased as dietary tallow level was increased to 3 and 4.5% but decreased when the level was increased to 6%, although milk fat concentration increased linearly and the protein level was unchanged. These results suggest beneficial usage by lactating Alpine does of low to moderate levels of partially hydrogenated tallow in diets moderate in concentrate level, although ingredient availability and costs will influence ultimate dietary ingredient decisions.
Journal Article↗
Lactic acidosis and hepatic steatosis associated with use of stavudine: report of four cases.
BACKGROUND: An association between use of zidovudine and didanosine and a rare but life-threatening syndrome of hepatic steatosis, lactic acidosis, and myopathy has been reported. OBJECTIVE: To describe the syndrome of hepatic steatosis, lactic acidosis, and myopathy in four patients taking stavudine. DESIGN: Case series. SETTING: A community hospital in Washington, D.C., and National Institutes of Health Clinical Center, Bethesda, Maryland. PATIENTS: Two men and two women with HIV-1 infection who were taking stavudine presented with lactic acidosis and elevated levels of aminotransferases. All patients required intensive care. MEASUREMENTS: Levels of lactic acid, alanine aminotransferase, aspartate aminotransferase, amylase, and lipase; computed tomography of the abdomen; liver biopsy (two patients); and muscle biopsy (two patients). RESULTS: Histologic findings consistent with mitochondrial injury confirmed the diagnosis of hepatic or muscle abnormality. CONCLUSION: Because hepatic steatosis may be life-threatening, physicians should consider it as a possible cause of elevated hepatic aminotransferase levels among patients taking stavudine.
Acidosis, Lactic↗
Growth of Spanish, BoerxAngora and BoerxSpanish goat kids fed milk replacer.
Seventy-seven male kids were used to compare growth performance of Spanish (S, n=26), BoerxAngora (BA, n=21) and BoerxSpanish (BS, n=30) kids during the preweaning period. All kids were removed from does 3 days postpartum, moved indoors and randomly allocated to individual cages. Kids received goat milk fortified with milk replacer for approximately 1 week followed by 600ml of milk replacer (23% CP, 30% crude fat) twice daily until weaning at 8 week. At 3 week of age, all kids had ad libitum access to a commercial goat starter diet (20% CP). Feed intake was measured daily and BW gain at 2-week intervals. There were interactions (P<0.05) between breed and time or 2-week period in BW, BW gain and feed efficiency. Boer crosses (i.e., BA and BS) were heavier than S kids at 2, 6 and 8 weeks of age (P<0.05), but there were no BW differences between Boer crosses (P0.10). From Week 3-8, Boer crosses gained BW more rapidly (P=0.001) than did S kids (60, 71 and 77g/day for S, BA and BS, respectively), although BW gain of S in Week 3-4 was greater (P<0.05) than that of Boer crosses (60, 50 and 54g/day for S, BA and BS, respectively). Starter diet DM intake in Week 3-8 was greatest for BS (S versus BA and BS, P=0.05; BA versus BS, P<0.01) (23, 24 and 37g/day for S, BA and BS, respectively). The ratio of BW gain to total DM intake in Week 3-8 was greater (P=0.03) for BA and BS than for S (0.52, 0.59 and 0.58 for S, BA and BS, respectively). The incidence of scours was 17, 21 and 31% for S, BA and BS kids, respectively (P0.10). These results reflect that crossbreeding with Boer goats can improve growth of young kids and, thus, potentially increase economic returns for goat producers.
Journal Article↗
Effects of dietary protein concentration on postweaning growth of Boer crossbred and Spanish goat wethers.
Boer (3/4) x Spanish (1/4) (BC; n = 23) and Spanish (SP; n = 22) goat wethers, 4 to 4.5 mo of age and 17.6 and 19.4 kg initial BW, respectively (SE = 0.57), were used to determine effects on growth of protein concentration in 70% concentrate diets provided for ad libitum intake for 30 wk in confinement. Offered diets contained 10.2, 14.2, 18.3, and 23.6% CP (DM basis), and CP concentration in consumed DM was 9.3, 13.8, 17.1, and 22.1% (P1, P2, P3, and P4, respectively); supplemental protein was from soybean meal for P1 and P2 and from soybean meal plus a blend of blood, fish, and feather meals for P3 and P4. Dry matter intake was similar between breeds and among diets (732, 712, 698, and 740 g/d for P1, P2, P3, and P4, respectively; SE = 27.0). Average daily gain was greater for P2 (P = 0.07) and P4 (P < 0.05) than for P1 (76, 90, 85, and 100 g/d for P1, P2, P3, and P4, respectively; SE = 5.3) and for BC than for SP (97 vs 78 g/d, SE = 3.7; P = 0.05). Similarly, ADG:DMI was lowest (P < 0.05) among diets for P1 (0.106, 0.126, 0.121, and 0.132 for P1, P2, P3, and P4, respectively; SE = 0.0053) and greater (P < 0.05) for BC than for SP (0.135 vs 0.108; SE = 0.0037). In conclusion, with 70% concentrate diets, the protein requirement for both BC and SP seemed to have been met by consumption of diets with at least 14% CP, with no apparent benefit from addition of ruminally undegraded protein.
Animal Feed↗
Behavioral risk management. A partnership between occupational health nursing and occupational psychiatry.
1. The estimated prevalence of behavioral disorders among adults in the United States is 29.5%, affecting more than 52 million individuals each year. 2. Numerous or persistent problems in work performance increase the likelihood of either a psychiatric illness or unresolved psychosocial factors. Assessing work functions can help identify individuals early on with potential warning signs for employment problems. 3. Occupational health nurses can partner with occupational psychiatrists to clarify the complex scenarios that present to companies and recommend intervention. 4. Proactive intervention for employees, an effective team, and input and participation from the various stakeholders can produce positive outcomes for both the employee and the employer.
Adult↗
Young clients' exposure to community violence: how much do their therapists know?
Although experiences of community violence are widespread and may have deleterious psychosocial consequences for children and youth, results of this exploratory study indicate that therapists lack substantial knowledge of their young clients' exposure to such violence. These findings suggest a need for professionals to adopt strategies to assess more systematically the role of community violence exposure in the problems presented by youth.
Adolescent↗