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Biomedical subjects

M Darby

Publications and source records attributed to M Darby.

At least 19 recordsLinked to original sources
PubMed2006

A laboratory study to determine the effects of universal and rotating ultrasonic inserts on wrist movement and scaling time efficiency of dental hygienists.

PURPOSE: The purpose of this study was to determine if differences existed in range of wrist movements and scaling time efficiency of dental hygienists using a rotating ultrasonic insert when compared with a standard universal insert. METHODS: A convenience sample of 32 consenting experienced dental hygienists who met inclusion criteria was invited to participate. Using a cross-over research design, the 32 participants were randomly assigned to one of the two subgroups. Subgroup A (n = 16) used the rotating universal ultrasonic insert on a typodont, rested for 15 min and the standard universal insert on a different typodont. Subgroup B (n = 16) used the standard universal ultrasonic insert on a typodont, rested for 15 min and the rotating universal ultrasonic insert on a different typodont. Each participant used the rotating and standard universal ultrasonic scaling inserts to remove 2 cm3 artificial calculus from two different typodonts for up to 15 min per insert. Scaling time efficiency was determined using a Modified Volpe-Manhold Calculus Index, measuring the amount of artificial calculus remaining after ultrasonic scaling. While scaling, each participant wore the WristSensor goniometry gloves, which determined changes in wrist movements (flexion and extension and ulnar and radial deviations), measured as a deviation from the neutral position. RESULTS: A paired t-test (P = 0.05) using 30 subjects with useable data, revealed no statistically significant differences between the two different inserts in terms of wrist movements and scaling time efficiency. A multivariate analysis of variance revealed no statistically significant differences in the percentage of time dental hygienists were in high, medium or low-risk posture categories while using the rotating ultrasonic insert compared with the standard universal insert. Based on the results of this laboratory study, dental hygienists using a rotating ultrasonic insert appear to experience no ergonomic advantage in terms of wrist postures or timesavings over a standard insert.

Cross-Over Studies↗
PubMed2005

Treatment of chronic anal fissure by application of L-arginine gel: a phase II study in 15 patients.

PURPOSE: Local application of exogenous nitric oxide donors, such as isosorbide dinitrate and glyceryl trinitrate, promotes fissure healing by reducing anal resting pressure and improving anodermal blood flow. The major drawback of these nitric oxide donors is headache. The overall incidence of this side effect is approximately 40 percent. Recently we have shown in healthy volunteers that L-arginine, being an intrinsic precursor of nitric oxide, reduces anal resting pressure without headache as a side effect. The aim of the present study was to evaluate the effect of L-arginine on anal resting pressure, anodermal blood flow, and fissure healing in patients with chronic anal fissure. METHODS: Fifteen patients with a chronic anal fissure were included in the present study. Before entering the study 10 patients were unsuccessfully treated by local application of isosorbide dinitrate. Six of these patients experienced severe headache during treatment with isosorbide dinitrate. All patients were treated for at least 12 weeks by local application of a gel containing L-arginine 400 mg/ml five times a day. In patients with a persistent fissure, treatment was continued until 18 weeks. Anal manometry and laser Doppler flowmetry of the anoderm were performed before treatment, 20 minutes after local application of the first dose, and after 12 weeks of treatment. A visual analog scale was used to assess fissure-related pain and headache. RESULTS: One patient dropped out after one day of treatment, and one was excluded because of violation of the study protocol. After 12 weeks of treatment complete fissure healing was observed in 3 of 13 (23 percent) patients, and after 18 weeks the healing rate was 8 of 13 (62 percent) patients. None of the 13 patients experienced typical nitric oxide-induced headache. The pressure recordings showed a significant reduction of maximum anal resting pressure (mean +/- SD): pretreatment 89 +/- 17 mmHg; 20 minutes after application of the first dose 67 +/- 17 mmHg; 12 weeks after treatment 74 +/- 14 mmHg (P < 0.005). Recordings of anodermal blood flow showed a significant increase in flow: pretreatment 0.36 +/- 0.25 volts; 20 minutes after application of the first dose 0.59 +/- 0.27; 12 weeks after treatment 0.64 +/- 0.33 (P < 0.005). CONCLUSIONS: Local application of L-arginine promotes fissure healing without headache as a side effect, and L-arginine is effective even in patients not responding to isosorbide dinitrate treatment.

Administration, Topical↗
PubMed2005

Long-term follow-up of retrograde colonic irrigation for defaecation disturbances.

OBJECTIVE: Irrigation of the distal part of the large bowel is a nonsurgical alternative for patients with defaecation disturbances. In our institution, all patients with defaecation disturbances, not responding to medical treatment and biofeedback therapy, were offered retrograde colonic irrigation (RCI). This study is aimed at evaluating the long-term feasibility and outcome of RCI. METHODS: Between 1989 and 2001, a consecutive series of 267 patients was offered RCI. All patients received instructions about RCI by one of our enterostomal therapists. Twenty-eight patients were lost to follow-up. A detailed questionnaire was sent by mail to 239 patients. The total response rate was 79% (190 patients). Based on the returned questionnaires it became clear that 21 (11%) patients never started RCI. The long-term feasibility and outcome of RCI was therefore assessed in the remaining group of 169 patients. Thirty-two patients were admitted with soiling, 71 patients with faecal incontinence, 37 patients with obstructed defaecation and 29 had defaecation disturbances after low anterior resection or pouch surgery. RESULTS: According to the returned questionnaires, RCI was considered effective by 91 (54%) patients. Among patients with soiling and faecal incontinence, RCI was found to be effective in, respectively, 47 and 41% of the subjects. Despite of the reported effectiveness, 10 (67%) patients with soiling and 5 (17%) patients with faecal incontinence decided to stop. Among patients with obstructed defaecation and those with defaecation disturbances after low anterior resection or pouch surgery the effectiveness of RCI was found to be 65 and 79%, respectively. None of these patients ceased their therapy. The overall success-rate of long-term RCI was therefore 45%. CONCLUSIONS: Long-term RCI is beneficial for 45% of patients with defaecation disturbances. In the group of patients who considered RCI effective and beneficial, discontinuation of therapy was only observed among those with soiling and faecal incontinence.

Adolescent↗
PubMed2003

Can we successfully maintain risk patients?

The most fundamental premise in the current view of periodontal disease is that not all individuals are at equal risk for disease and disease progression. Studies reveal that about 5-20% of the population is at risk for severe disease progression. The purpose of this paper is to define at-risk patients, review risk factors and indicators of disease progression, and outline an evidence-based strategy that includes both self-care and professional care for maintaining periodontal health. Risk factors/risk indicators considered include history of previous disease, increased pocket depth and loss of clinical attachment, frequency of dental care, specific bacterial pathogens, and systemic/environmental host factors such as smoking, diabetes mellitus, genetics, and stress. Because host factors may have more influence on disease progression than periodontal pathogens, personal and professional maintenance care must include the role of the host in periodontal disease progression. By examining the evidence surrounding these complex issues, dentists and dental hygienists are able to determine the extent to which evidence supports available approaches to maintain periodontal health and control disease progression.

Diabetes Complications↗
PubMed2002

[Sacral neuromodulation is effective in the treatment of fecal incontinence with intact sphincter muscles; a prospective study].

OBJECTIVE: To evaluate the therapeutic effect of sacral neuromodulation on faecal incontinence in patients with structurally intact sphincters. DESIGN: Prospective. METHOD: In the period April 1st, 2000 to November 30th, 2001, patients with faecal incontinence and structurally intact sphincters were included, with or without previous surgery, in whom medicinal treatment and biofeedback therapy gave no improvement. Incontinence was defined as involuntary loss of stool at least once a week, which was objectified by completion of a 3-week bowel habit diary. Patients underwent 3 weeks of trial stimulation during which they also kept a diary. The trial stimulation was considered successful if the diary showed a > or = 50% improvement in continence. RESULTS: 38 patients (31 women) with an average age of 54 years (range: 26-73) underwent trial stimulation. Trail stimulation was carried out using a permanent electrode in 6 patients and using peripheral neural evaluation in the remaining 32 patients. Two patients did not respond to peripheral neural evaluation. Upon assessment after the trial stimulation period. continence was found to have improved by > or = 50% in 31 (82%) patients. The number of incontinence episodes decreased by an average of 86% (range: 50-100). In 27 patients an implantable pulse generator was implanted for continuous stimulation. During the average follow-up of 6 months the effect remained satisfactory. Anal manometry during stimulation showed no increase of sphincter pressures. CONCLUSION: Sacral neuromodulation was of therapeutic value in most of the patients treated for faecal incontinence without sphincter damage.

Adult↗
PubMed2000

Pediatric renal transplantation in the Netherlands.

In the Netherlands, pediatric kidney transplantation programs are available in four centers. We retrospectively analyzed the results obtained over the past decade. Between 1985 and 1995, 231 patients (139 boys) received 269 transplants, including 61 repeat. The recipients were aged 1.9-21.8 yrs (mean 10.9), the donors 0.3-63.3 yrs (median 11.4, mean 19.7). Immunosuppression consisted of corticosteroids, cyclosporin A and azathioprine, in various combinations and dosages. The patient survival during follow-up was 97%. The overall graft survival was 73% at 1 yr and 60% at 5 yrs after transplantation. Major causes of graft loss were acute rejection (21%), thrombosis (12%) and chronic rejection (28%). Acute rejection episodes were noted in 74% of all grafts. First acute rejection episodes had a moderate predictive value for graft loss (relative risk (RR), compared to rejection-free grafts, 5.9). First rejection episodes occurring later than 3 months after transplantation were considerably more predictive (RR 18.3) than early ones. Grafts from living related donors (n = 35) yielded a superior 5-yr graft survival (77%) and remained free of rejection more often than grafts from adult cadaveric donors(43% vs. 25%). The results of pre-emptive transplants were excellent (n = 13, 5-yr survival 100%). Repeat transplants had the same results as primary transplants. Recipients younger than 4 yrs showed a poor 5-yr graft survival of 38% (n = 13). Single kidney grafts from donors younger than 4 yrs (n = 35) had a 5-yr graft survival of 44%. In contrast, kidneys from these young donors did well if transplanted en bloc (n = 10, 5-yr graft survival 89%). These overall results are in line with those of others. The results may be improved by expansion of immunosuppressive therapy in the first year and by thrombosis prophylaxis in high-risk patient-donor combinations. Better results may be expected from more extensive use of living related donations, pre-emptive transplantation and en bloc transplantation instead of single kidneys of young donors.

Adolescent↗
PubMed2000

Sexual harassment in dentistry: experiences of Virginia dental hygienists.

PURPOSE: The purpose of this study was to determine if dental hygienists in the Commonwealth of Virginia experienced sexual harassment while employed in oral health care settings. Other interests were to determine if dental hygienists experienced sexual harassment, to what extent they felt professionally prepared to respond to unwanted sexual behaviors; did they perceive sexual harassment as a problem in the oral health care environment; and was attrition from their employment associated with sexual harassment. METHODS: A questionnaire, Sexual Harassment in the Dental Hygiene Profession, designed by the author, was used in this research. A list of currently licensed and registered dental hygienists was obtained from the Virginia Board of Dental Examiners and the questionnaire was sent to 540 randomly selected registered Virginia dental hygienists. Two weeks after the initial mailing, a second questionnaire was sent to non-respondents. The survey elicited data on experience, management, and personal opinions relative to sexual harassment, as well as demographic information. Results were analyzed using frequencies, percentages, and the chi-square test of association. RESULTS: Two hundred eighty-five surveys (53%) were returned and useable. Findings revealed that 54% of the responding dental hygienists experienced sexual harassment. Of these, 50% experienced sexual harassment four or more years ago, 23% one to three years ago and 28% within the last year; these categories were mutually exclusive. The perpetrators of the harassment were reported to be either male dentists (73%) or male clients (45%). Less than 10% reported being harassed by women. While 70% of the sexually harassed respondents indicated that filing formal complaints was an effective strategy for managing sexual harassment, less than 1% actually did so. Of all dental hygienists (harassed or not), 90% did not receive training in their dental education to manage sexual harassment, and 85% would like the American Dental Hygienists' Association to develop model guidelines and policies. Demographic characteristics were typical of practicing dental hygienists in Virginia; 99% female, 96% Caucasian, and 86% married with a mean age of 40 years. CONCLUSION: Information about managing sexual harassment needs to be incorporated into the dental hygiene curricula. This curriculum addition should include information on identifying sexual harassment incidents, strategies for controlling unacceptable behavior, the legal rights of employees, and the process of filing a formal complaint. Dental hygienists need to identify sexual harassment behaviors and receive prevention training though continuing education courses. Furthermore, the American Dental Hygienists Association and the American Dental Association need to collaboratively develop guidelines and policies for dentists and dental hygienists regarding the management of sexual harassment in the oral health care setting.

Adult↗
PubMed1999

Comparison of 2D conventional, 3D conformal, and intensity-modulated treatment planning techniques for patients with prostate cancer with regard to target-dose homogeneity and dose to critical, uninvolved structures.

The purpose of this study was to compare 2-dimensional (2D), 3-dimensional (3D) and intensity-modulated radiation therapy (IMRT) techniques for external-beam radiation treatment for prostate cancer. Dose homogeneity within the target volume and doses to critical, uninvolved anatomic structures were evaluated. Computed tomography (CT) scans of 3 patients with localized prostate cancer (T2NOM0) were acquired and transferred to the treatment planning systems. The target volume and uninvolved structures were contoured on axial CT slices throughout the volume of interest. A comparison of the 3 treatment techniques was performed using isodose distributions, dose statistics, and dose-volume histograms. Dose homogeneity was found to be most uniform with the 2D technique; however, the 2D technique delivers unnecessary radiation doses to the rectum and bladder. The dose conformity observed with IMRT is increased compared with that observed with the 3D technique, as is the sparing of critical uninvolved structures; however, dose homogeneity appears to be worse with IMRT than with the 3D technique. Overall, of the 3 techniques, IMRT offers the most conformity in delivery of tumoricidal doses to the prostate while sparing dose to critical, uninvolved structures. Association of Medical Dosimetrists.

Femur Head↗
PubMed1999

Optimal staffing for hospitals: in search of solutions.

The best staffing models are those that give nurses and other caregivers control and flexibility in their work, say administrators who are fighting higher acuity, tighter budgets and shorter patient stays as well as the threat of staff burnout. Specialty float pools, well-trained students and carefully defined job charters all can ease the strain, staffing experts say.

Efficiency, Organizational↗
PubMed1999

Coordinating care in an integrated delivery system.

To keep patients from falling through the cracks, each point of service in a healthcare system must understand its role in the patient's overall care and have access to the right information at the right time. Communication and a system's organization play significant roles in making coordinated care work: Some health systems prefer to keep patients with common diagnoses in service lines that take them from preadmission to home care; others set up separate organizational entities to coordinate care for all patients with chronic illness. Regular meetings on patient status, standardized forms and clear job descriptions all help minimize confusion.

Case Management↗
PubMed1998

Health care quality: from data to accountability.

The many audiences for information about the quality of health care have different and sometimes conflicting interests and priorities. This is reflected in the diversity of current efforts to use health care data to identify, measure, and demonstrate quality. The author surveys three of these approaches in depth: (1) the professional approach, which relies on the actions of private-sector accreditation groups, trade associations and health plans, hospitals, and other providers to assure quality; (2) the market-driven approach, which relies on the use of quality data by health care purchasers and consumers in choosing plans and providers; and (3) the public-sector approach, which relies on the regulatory, oversight, and purchasing actions of government at the federal, state, and local levels to assure quality. The author concludes that efforts to measure and report the quality of health care invariably confront a variety of technical and political issues. Several observers maintain that it is more important for participants in quality issues to reach consensus on the issues than to reach technical perfection in the way the data are handled. Important obstacles in the technical realm include inadequate investment in sufficiently sophisticated and compatible information systems and the fact that where such systems are in place, they generally cannot be linked. But efforts, both technical and legal, are under way to overcome these obstacles. Even so, some of the issues of health care quality will remain moving targets because of constant changes in the health care environment and in technology. The author closes with the hope that the various actors within the health care industry may coordinate their efforts in dealing with these issues.

Accreditation↗
PubMed1998

Making the most of data for disease management.

Managed care organizations have a wealth of administrative, claims and clinical data available to them--data that could pinpoint patients who could benefit from cost-effective disease management programs. Health plans that have such efforts offer advice on how to home in on the best data.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1997

Use of thermoluminescent dosimetry to verify dose compensation in total body irradiation.

For Total Body Irradiation (TBI) the midline dose along the long axis of the body should vary by no more than +/- 10% compared to the dose received at the prescription point. Compensating filters are often made to compensate for contour irregularities. This paper describes an experimental method using Thermoluminescent Dosimetry (TLD) to verify the appropriateness of dose compensation provided by compensating filters. An AP/PA treatment geometry was used with an 18 MV photon beam. TLDs were placed in the midplane and on the surface of an anthropomorphic phantom in five different areas. Three different lead compensating filters were designed to provide proper compensation, overcompensation, and undercompensation. The TLD readings were compared with calculated doses and the measurements correlated favorably. The measurements were sensitive enough to detect dose variations due to improper compensation. These results demonstrate that TLD is a reliable method of verifying dose compensation provided by compensating filters in TBI.

Humans↗