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PubMed1989

Giving LTC residents that secure feeling. Risk management and loss prevention techniques.

Nursing homes today are promoting the physical, emotional, and psychosocial security of their residents while involving them and their families in the ultimate decision making. These efforts, however, do not minimize nursing homes' responsibility to ensure a secure environment through good risk management and loss prevention techniques. Facility managers should annually evaluate policies and procedures to ensure that department standards are realistic and reflect the accepted standard of care owed to residents. Technological and functional developments in healthcare make continuous staff training programs a necessity. Involving patients and their families in care planning and treatment decisions can enhance residents' feelings of security. These feelings are further bolstered by a safe environment. Staff should also be alert to changes in residents' behavior. When a resident is admitted to a nursing home, managers should obtain signed consent forms for potential future medical treatment and resident trips. Managers' responsibilities also extend to situations beyond their control. All long-term care facilities must have practical plans in case of natural disasters.

Accident Prevention↗
PubMed1999

Direct-placement gallium restorative alloy: a 3-year clinical evaluation.

OBJECTIVE: A pilot clinical study on a direct-placement gallium restorative alloy was initiated with nine patients who signed a consent form. METHOD AND MATERIALS: Thirty Class I restorations were placed and assessed over a 3-year period. The cavity preparations and surface of the restorations were sealed to prevent oral fluids from contacting the gallium alloy during placement and early setting of the gallium restorative material. RESULTS: The initial 18-month clinical results were encouraging. But at 21 months, one tooth had fractured, and within another year two molars were diagnosed with cracked-tooth syndrome (incomplete tooth fracture). These three fractured teeth were restored with amalgam and are symptomless at this time. There was little fracture at the margins of the gallium restorative, but tarnish and a rough surface were noted on many of the gallium restorations. The direct-placement gallium restorative alloys must be further assessed in the laboratory to correct dimensional instability. CONCLUSION: Results suggested that Galloy, used with either of two sealing resins, is not a suitable restorative material.

Dental Alloys↗
PubMed1999

Knee kinetics during functional electrical stimulation induced cycling in subjects with spinal cord injury: a preliminary study.

The purpose of this preliminary study was to describe pedal effectiveness parameters and knee-joint reaction forces generated by subjects with chronic spinal cord injury (SCI) during functional electrical stimulation (FES)-induced bicycling. Three male subjects (age 33-36 years old), who were post-traumatic SCI (ASIA-modified level A, level T4-C5) and enrolled in an FES rehabilitation program, signed informed consent forms and participated in this study. Kinematic data and pedal forces during bicycling were collected and effective force, knee-joint reaction forces, knee generalized muscle moments, and knee-joint power and work were calculated. There were three critical findings of this study: 1) pedaling effectiveness was severely compromised in this subject population as indicated by a lack of overall positive crank work; 2) knee-joint kinetics were similar in magnitude to data reported for unimpaired individuals pedaling at higher rates and workloads, suggesting excessive knee-joint loading for subjects with SCI; and 3) shear reaction forces and muscle moments were opposite in direction to data reported for unimpaired individuals, revealing an energetically unfavorable knee stabilizing mechanism. The critical findings of this study suggest that knee-joint kinetics may be large enough to produce a fracture in the compromised lower limbs of individuals with SCI.

Adult↗
PubMed2000

Determinants of hospital admission among HIV-positive people in British Columbia.

BACKGROUND: This study was initiated to evaluate the demographic and clinical determinants of admission to hospital among HIV-positive men and women receiving antiretroviral therapy in British Columbia. METHODS: The analysis was restricted to participants enrolled in the HIV/AIDS Drug Treatment Program between September 1992 and March 1997 who had completed an annual participant survey, had a viral load determination and had signed a consent form allowing electronic access to their inpatient hospital records. A record linkage was conducted with the BC Ministry of Health to obtain all records of hospital admissions from April 1991 to March 1997. Statistical analyses were carried out using parametric and nonparametric methods and multivariate logistic analyses. RESULTS: The study sample comprised 947 participants (859 men, 88 women). Of these, 165 (17%) were admitted to hospital during the study period from May 1, 1996, to Mar. 31, 1997. The median number of admissions was 1 (interquartile range [IQR] 1-2 admissions), and the median length of stay per admission was 3 days (IQR 1-8 days). Admission to hospital was associated with being unemployed (82% of those admitted v. 58% of those not admitted), being an injection drug user (24% v. 17%), reporting a fair or poor health status (46% v. 29%) and having a physician experienced in the management of HIV/AIDS (31% v. 24%). Examination of clinical determinants demonstrated that hospital admission was associated with a previous admission (72% v. 46%), a high viral load (median 74,000 v. 14,000 HIV-1 RNA copies/mL), a low CD4 count (median 0.16 v. 0.27 x 10(9)/L) and an AIDS diagnosis (44% v. 24%). Multivariate logistic regression analysis revealed that being admitted to hospital was independently associated with being unemployed (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.66-4.20), having been previously admitted to hospital (OR 2.30, 95% CI 1.53-3.46), having a high viral load at baseline (OR 1.45, 95% CI 1.16-1.80), being an injection drug user (OR 1.63, 95% CI 1.02-2.62) and having an experienced physician (OR 1.98, 95% CI 1.29-3.03). INTERPRETATION: Hospital admission among participants in this study was found to be associated with marginalization and poor health status.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Allergic reactions and pseudoallergies in surgical interventions with general anesthesia].

The Spanish Societies of Allergology and Anesthesiology have established a protocol for action for the performance of allergy tests for anesthesia. The protocol was published by the General Directorate of INSALUD, along with an informed consent form for general and loco-regional anesthesia, on 30 June 1994. Despite this, demands for care and requests for allergologic and anesthetic studies have increased. This review examines the diagnostic, preventive, and therapeutic criteria for adverse reactions during general anesthesia according to the most relevant international literature. Pseudoallergic reactions are one of the most frequent and important adverse reactions that occur during general anesthesia. These reactions are caused by the release of histamine and, probably, other mediators. The histamine-releasing effect depends on the dose of the medication. The most potent medications are morphine and almost all muscular relaxants, in the following proportions (succinylcholine: 43%; vecuronium: 37%; pancuronium: 13%; alcuronium: 76%; atracurion: 6.8%; galamine: 56%). Somewhat less than 50% of all severe intraoperative allergic reactions are really anaphylactoid reactions. The mediators involved in anaphylactic/anaphylactoid responses are: IgE in type I hypersensitivity mechanisms, IgA, immunocomplexes, complement activated by an alternative pathway, tryptase, and histamine. Numerous and varied agents are involved. Table III lists general intravenous anesthetics; table IV shows muscular relaxants. According to national studies, intraoperative latex sensitization occurs in 1% to 5% of health-care personnel and 40% of children with spina bifida. More than 6% of blood donors have IgE against latex. Cross-reactions between latex and fruit proteins, such as banana and kiwi, have been reported. As many as 50% of patients with latex allergy have such cross-reactions, according to some authors. Diagnostic methods include skin tests, challenge, histamine release test, RIA, human basophil optical degranulation test, and ImmunoCAP. Skin tests are the technique most often used in Allergology Units in Spain. Risk factors are debated. Although the female sex is accepted as predominant, atopy is controversial. The only known negative factor is the insertion of an endotracheal tube in asthmatic patients. Prevention should begin with the selection of less potent drugs, such as histamine releasing agents. Slow administration of drugs, as opposed to bolus administration, has been demonstrated to be more effective. The use of combined H1 and H2 antihistamines as a preanesthetic medication can significantly reduce tachycardia/bradycardia, hypotension, skin response, and even gastric pH changes induced by histamine release.

Anaphylaxis↗
PubMed1999

Research challenges to recruitment and retention in a study of homebound older adults: lessons learned from the nutritional and dental screening program.

This paper attempts to describe the many reasons why it is difficult to recruit homebound older adults to participate in research studies. The reasons, not surprisingly, are more practical than theoretical. Complicated procedures for participants to follow, cross-cultural communication, fear of the medical establishment, convoluted consent forms, making contact on the telephone, finding the participants' homes, and a host of other nagging problems combine to erect enormous barriers to running successful studies. It is our hope that in identifying these difficulties we will also shed light on how to design studies that minimize their impact.

Aged↗
PubMed2000

Teaching nightguard bleaching and other tooth-whitening procedures in North American dental schools.

Tooth-whitening using carbamide peroxide delivered in a custom-fitted tray (nightguard bleaching) is a relatively new procedure, yet it is currently one of the most commonly used types of esthetic dental treatment in private practice. This study determined the extent that nightguard bleaching (NGB) has been included in dental school curricula. All sixty-five dental schools in North America were surveyed about curriculum content and treatment protocol for the use of nightguard and other bleaching procedures, generating an 82 percent response. The survey covered eighteen subject areas related to NGB ranging from clinical requirements and indications to products and recall intervals used. The most commonly taught tooth-whitening procedure was NGB, which was most often taught by operative and restorative faculty. Although no schools had clinical requirements for NGB, 92 percent taught it. The most common indications for NGB were esthetic shade change and pre-restorative lightening of teeth. Unrestored caries, defective restorations, and pre-existing sensitivity were common contraindications. Most schools do not use a specific NGB consent form, but most use written patient instructions. Most schools use at least two different NGB products, bleach for two to four weeks, and use reservoired and scalloped trays. An average of 25 percent of NGB patients were estimated to develop sensitivity, for which treatment recommendations include fluoride, desensitizing toothpaste, and reduced exposure time. Curriculum time and safety concerns were reasons for not teaching NGB (8 percent schools). Most schools indicated that the relative importance of NGB in the curriculum was increasing.

Canada↗
PubMedDate not supplied

Laparoscopic colonic resections versus open surgery: a prospective non-randomized study on 310 unselected cases.

BACKGROUND/AIMS: Laparoscopic colorectal surgery, particularly for malignancy, is still debated. The aim of this study was to prospectively evaluate the postoperative outcome as well as the short- and medium-term results of laparoscopic surgery compared with those after open conventional surgery. METHODOLOGY: A series of 310 consecutive patients, operated on by the same surgical team, have been included in this study; 150 patients (75% with malignant lesions) underwent laparoscopic surgery, whereas 160 patients (73% with malignant lesions) were treated by open surgery. The treatment modality was selected by the patients after reading the informed consent form. RESULTS: Laparoscopic surgery was technically feasible in 91.4% of cases. Mean operative time for laparoscopic surgery was longer than for open surgery (251 vs. 175 min) (P < 0.001). Mean postoperative hospital stay after laparoscopic surgery was 10.5 days, as compared to 13.3 days after open surgery (P < 0.05). In the laparoscopic surgery group minor complications' rate was 3.6% and compared favorably to the 7.5% observed after open surgery (P = 0.261). No statistically significant difference was observed in the major complications rate (9.4% after laparoscopic surgery and 6.8% after open surgery) and in operative mortality (1.4% for laparoscopic surgery and 0.6% for open surgery). The local recurrence rate was lower after laparoscopic surgery as compared to open surgery: 3% versus 9.2% (P = 0.152), respectively. Mean follow-up was 34.2 months during which time we observed 2 cases of port site recurrence. After implementing adequate prophylactic measures, no parietal implants were observed in the last 80 patients who underwent laparoscopic surgery for malignancy. Distant site metastases occurred in 11% in both groups. At 36 months cumulative survival probability in laparoscopic surgery completed malignant cases was 0.74% as compared to 0.66% after open surgery. CONCLUSIONS: Morbidity and mortality were similar in the 2 groups. Laparoscopic patients experienced less pain. A slightly higher incidence of local recurrence was observed in the open surgery group, whereas the percentage of distant site metastases and the cumulative survival probability in the 2 groups were similar. Port site recurrences are a cause of concern but they can be prevented with adequate prophylactic measures. The short- and medium-term results of laparoscopic surgery compared favorably with those of open surgery in this prospective non-randomized study. Long-term oncological result are not known yet. In patients with malignancy prospective randomized trials on larger patient numbers are required.

Colectomy↗
PubMed2000

Experience with self-administered emergency contraception in a low-income, inner-city family planning program.

OBJECTIVE: To evaluate women's use, knowledge of and attitudes toward self-administered emergency contraceptive pills (ECP) at the University of Pennsylvania family planning clinic (FPC). STUDY DESIGN: The University of Pennsylvania FPC is a Title X, publicly funded clinic serving urban, low-income women. All women attending the clinic were offered ECP packets. Exclusion criteria for ECP were current pregnancy or newly diagnosed hypertension. Women signed consent forms and were given specific instructions on using ECP with the standard Yuzpe method. Women were contacted for a phone interview after they had the ECP packets at home for six to eight months. RESULTS: One hundred ninety-two women received the ECP packets. Forty-eight were contacted and completed the survey. One hundred forty-four women had moved, no longer had phone service or were unreachable after three or more attempts. Eleven of the 48 women (22.9%) used the ECP, but only 2 of 11 (18.2%) took the pills correctly. One of these two women became pregnant. Of the women who had not used the ECP packets, only 25 of 37 (67.6%) could locate them, and only 9 of 37 (24%) could recall how to use them correctly. Four of 37 (10.8%) experienced an unplanned pregnancy. CONCLUSION: Emergency contraception utilization was far lower than anticipated, suggesting that ready access is not the only issue. Many of the women did not administer ECP correctly or could not state how they would use it in the future despite extensive instruction. Patients will require new and creative approaches to encourage their appropriate use of emergency contraception.

Adult↗
PubMed2001

An effect of hormone replacement therapy on skin thickness in early postmenopausal women.

BACKGROUND: It is well known that dermal thickness, the major component of skin thickness, will decrease progressively after menopause. Bone and dermis share a similar organic constituent (collagen type I). The effect of hormone replacement therapy on bone has been established, whereas, its effects on skin are less well-described. This study was performed to determine the effect of combined estrogen-progestin replacement therapy in a sequential regimen on skin thickness in women during the early postmenopausal period. METHOD: One hundred early postmenopausal women who met the eligibility criteria and had already signed a consent form were non-randomly allocated in two groups. Group A; sixty women who received cyclic hormone replacement therapy in each 28-day cycle for 6 cycles. Group B; forty women who received 1,000 mg of calcium carbonate daily. Skin thickness was measured by ultrasonography before and after treatment and the Student's t-test was used to compare the results. RESULTS: A statistically significant increase in skin thickness over baseline was noted after combined estrogen-progestin replacement therapy had been administered for 24 weeks compared to the control and baseline groups. The skin thickness was also significantly decreased after calcium had been administered for 24 weeks when compared to baseline. CONCLUSION: Skin thickness was increased in early postmenopausal women subjected to hormone replacement therapy with an alternating dose of estrogen and progestin.

Adult↗
PubMed2001

Prevalence and risk factors of Streptococcus agalactiae (group B) colonization in mothers and neonatal contamination at Srinagarind Hospital.

From July 1999 to November 1999, 901 pregnant women at Srinagarind Hospital, who fulfilled the criteria and had signed consent forms, were cultured from the lower vagina and perineum for group B streptococcus (GBS). Their neonates were also cultured from ears and anuses within 30 minutes after birth. There were 56 cases or 6.22 per cent colonization in pregnant mothers at the onset of labor and 14 cases or 1.55 per cent colonization in their neonates. Risk factors for GBS colonization in mothers were intrapartum fever and episiotomy. The risk factors for GBS colonization in the neonates were; 1. husband's occupation, 2. antepartum fever, 3. intrapartum fever, 4. postpartum morbidity and 5. gestational age. No cases during the study period had clinical infection from GBS. The prevalence rate in this study was much lower than the United States but similar to many developing countries. At this moment, it is not possible to culture for GBS in all pregnant women in Thailand. Intrapartum antibiotic prophylaxis for GBS infection was recommended if, 1. maternal fever was more than 38 degrees C, 2. ruptured membranes of more than 18 hours and 3. previous birth with neonatal GBS infection.

Female↗
PubMed2001

New-world and transcultural impact on Thai medical practices and professional behaviour.

Thailand, which is barely recovering from the 1997 economic collapse, has passed a new constitution, has a new government and all of this will have a profound effect on the way doctors practice and interact with their patients. Some of the factors that have been responsible for this are 1) Passage of a patient's rights bill 2) Legal definition of what is a proper consent form 3) The public's demand for openness, better communication and transparency in medicine These concepts, which now have a legal as well as moral basis, will impact directly on doctors and nurses as their practices will be subject to increasingly intense scrutiny and criticism. Doctors and nurses in past generations were among the most respected members of Thai society. They were trusted almost without exception and their judgment was not questioned. Only rare cases of malfeasance and malpractice came to public notice though, no doubt, they existed but to a much lesser degree. A physicians' life was much simpler for our teachers, fathers and grandfathers. Life was inexpensive, families were less demanding and the doctor did not have to surround himself with expensive foreign-made apparatus which can bankrupt the doctor as well as the patients who have to pay the bills. Medical decisions were made mostly on the basis of observation, past experience at the bedside and not in the laboratory or imaging rooms. Honest errors in diagnosis were common, treatment was limited and simple and this was all tolerated or expected by the public. Few if any disappointments on the part of patients ended up before a judge.

Attitude↗
PubMed2002

[First successful clinical application of tissue engineered blood vessel].

With this tissue engineering (TE) technique, the peripheral pulmonary artery was successfully reconstructed, using the patient's own venous cells in a 4-year-old girl, 2 years after Fontan procedure. A 4-year-old girl was given a diagnosis of single right ventricle, double-outlet right ventricle and pulmonary atresia. She underwent left modified Blalock-Taussig shunt at a month old, pulmonary artery angioplasty at a year and 3 months old, and bidirectional cavopulmonary shunt at 2 years and a month old. She underwent again pulmonary artery angioplasty and Fontan operation at 3 years and 3 months. An angiographical examination 7 months after the operation revealed total occlusion of the right intermediate pulmonary artery. TE technique using autologous cells was indicated. The application of this procedure was approved by the ethical committee in Tokyo Women's Medical University. The patient's parents were thoroughly informed and signed a consent form. Approximately 2 cm of the peripheral vein was explanted under sterile conditions. The tissue was minced, placed in tissue culture dishes and cultured at 37 degrees C, 100% humidity and a 5% CO2 atmosphere for almost a month. The number of cells substantially increased to reach 12 millions for almost a month. The culture medium was changed every 3 days. The polymer tube that served as a scaffold for cells was composed of the copolymer of PCL-PLA (50:50) with reinforcement by woven PGA. The polymer conduit, 10 mm in diameter, 20 mm in length and 1 mm in thickness, was designated to biodegradate within 8 weeks. The number of seeded cells was approximately a million/cm2. The graft transplantation was performed 10 days after seeding cells. The occlusive right intermediate pulmonary artery was reconstructed with the TE vessel graft under extracorporeal circulation with a pump-oxygenator. The patient followed a satisfactory postoperative course. The postoperative angiography demonstrated that the graft was not constricted and dilated but that it preserved good patency. Long-term follow-up are necessary. We plan to continue to use the TE technique using autologous cells in the low pressure system like venous or pulmonary circulation. Because our results even in early experimental phase were valuable and promising, we believe that the TE approach may play an important role in the near future as an another alternative, together with transplantation and artificial organ, especially in the field of cardiovascular surgery that mostly needs replants.

Blood Vessel Prosthesis Implantation↗
PubMed2002

[The BCTRIMS Expanded Consensus on treatment of multiple sclerosis: III. Evidence and recommendation-based guidelines].

There has been unprecedented advances in knowledge of multiple sclerosis (MS) in the last few years. A new set of criteria for its diagnosis and a bunch of recent clinical trials with disease-modifying agents (DMA) have been published. All of that has made it necessary to update and expand the previous consensus for MS treatment as formulated by the Brazilian Committee for Treatment and Research in Multiple Sclerosis (BCTRIMS) two years ago. The BCTRIMS Expanded Consensus emphasizes the need to (1) consider MS treatment on an individual basis; (2) educate patients about the potential benefits and risks of treatment; (3) monitor drugs side effects; (4) have a signed Informed Consent Form; (5) consider the relative cost of the drug. The various clinical possibilities and the indications of the DMA and other immunointerventions are considered according to classes of evidences and types of recommendations. The BCTRIMS Expanded Consensus on Treatment of MS may turn out to be a model to other developing countries.

Evidence-Based Medicine↗
PubMed2002

Intentional use of the Hawthorne effect to improve oral hygiene compliance in orthodontic patients.

The purpose of this study was to evaluate whether the home care of noncompliant adolescent orthodontic patients with "poor" oral hygiene could be improved through the use of a deception strategy designed to intentionally induce the Hawthorne effect. This effect is often cited as being responsible for oral health improvements of control groups that receive placebo treatments. It is thought that participating in and fulfilling the requirements of a study alters subjects' behavior, thereby contributing to the improvement. Forty patients with histories of poor oral hygiene were assigned, in a quasi-random fashion, to two groups. Experimental subjects (n = 20) were presented with a situation that simulated participation in an experiment. These included the use of a consent form; distribution of tubes of toothpaste labeled "experimental"; instructions to brush twice a day for two minutes using a timer; and a request to return unused toothpaste. Control subjects (n = 20) had no knowledge of study participation. Tooth surface area covered with plaque was used as a proxy measure of home care behavior. It was measured at baseline, three months, and six months. Mean percentages of tooth surface covered with plaque for the experimental and control groups were 71 (+/- 11.52) and 74 (+/- 11.46) at baseline; 54 (+/- 13.79) and 78 (+/- 12.18) at three months; and 52 (+/- 13.04) and 79 (+/- 10.76) at six months. No statistically significant difference (p > .05) was obtained between groups at baseline. Statistically significant differences (p < .05) were found between groups at three and six months. Significant differences (p < .05) were also found only for the experimental subjects between baseline and each of the two subsequent observation periods. The efficiency and potential effectiveness of this strategy suggest that additional research be conducted to assess oral health improvements and possible applications to the private practice setting.

Adolescent↗
PubMed2002

Sentinel node in management of malignant melanoma.

OBJECTIVE: One of the most important prognostic features of malignant melanoma is the involvement of regional lymph nodes. The aim of this study is to identify the sentinel lymph node which is the first node to be involved by metastases from malignant melanoma and then decide which patients can benefit from lymph node dissection and which will only need clinical follow-up. METHODS: Forty-four patients were included in this study from October 2000 to November 2001. The study was carried out at the St. Bartholomew's and Royal Hospital, London, United Kingdom. We undertook a pilot study of patients with malignant melanoma involving the outline technique. A consent form for all patients was taken. The only criteria for inclusion in this study was the Berslow thickness of the tumor which had to be over 2 mm. There were 18 females and 26 males, mean age of 57 years. The primary tumor site varied: upper limbs 14, lower limbs 10, trunk 18, and head and neck 2. RESULTS: Excision of one to 3 sentinel nodes (mean 1.4) was performed. The number of sentinel nodes was removed: one in 24 patients, 2 in 12, 3 in 6, and 4 in 2 patients. In 8/44 patients metastatic disease was detected in the sentinel node. Three patients had therapeutic lymph node dissection. There was no major complication. Four patients with one positive node each (evidence of micrometastases) have gone for lymph node dissection; one of them had one further positive node. CONCLUSION: Sentinel lymph node biopsy is increasingly used to stage melanoma in order to avoid lymph node dissection in patients who clinically have no lymph node involvement. Sentinel lymph node biopsy is a valuable technique for melanoma staging; however, impact on overall survival requires longer follow-up.

Female↗
PubMed2002

Clinical study to compare two in-office (chairside) whitening systems.

The objective of this clinical study was to compare the whitening/bleaching efficacy of two marketed in-office whitening systems: Discus Dental Zoom! Chairside System (25% hydrogen peroxide whitening gel) and Opalescence Xtra Boost Kit (38% hydrogen peroxide whitening gel), using the Vita Shade Guide and chromameter measurements. The study was an examiner-blind, parallel group, randomized and controlled clinical trial conducted in a dental setting. All subjects signed a study consent form prior to admission and were given Crest Regular Toothpaste and an Oral-B 40 straight-handle toothbrush to use during the study. Subjects received a supragingival prophylaxis followed by a screening eligibility Vita Shade assessment from which 22 subjects were selected. At baseline, all six maxillary anterior teeth were assessed with the Vita Shade Guide. Chromameter measurements were taken on either the right maxillary central or left maxillary central (tooth No. 8 or tooth No. 9). Subjects were assigned to one of two treatment groups, and had three applications of their assigned product. Following completion of the treatment phase, and on post-treatment Days 2 and 7, a visual examination of the condition of the oral soft tissues, together with a Vita Shade assessment on maxillary anterior teeth, a chromameter reading and a questionnaire regarding tooth sensitivity were completed. At the termination of the study, the statistical analysis of the Vita Shade scores indicated that both products significantly (p < 0.0001) lightened the color of the teeth. The average improvement was between 6 and 9 shade changes. Additionally, the Zoom! Chairside System was significantly better than the Opalescense Xtra Boost Kit at all time points: post-treatment (p < 0.0001); Day 2 (p < 0.004); Day 7 (p < 0.003). This difference was between 1 and 2 shade changes. The chromameter readings showed a significant difference in the overall color change (delta E) to a lighter color for both the Zoom! Chairside System and the Opalescence Xtra Boost Kit. Using delta E, the Zoom! Chairside System was directionally better than the Opalescense Xtra Boost Kit at Day 2 (p < 0.08), and significantly better at Day 7 (p < 0.025). Analysis of the composite parameters of delta E (L*, a*, b*) showed that no differences could be detected in the a* (redness) parameter. Changes were observed in the L* (brightness) and b* (yellow) parameters which paralleled the delta E differences. There were no significant differences in induced sensitivity between whitening systems at any time point.

Color↗
PubMed2003

[The therapeutic efficacy for ED patients treated with low dosage of PGE1].

OBJECTIVES: To evaluate the efficacy of intrameatal application of low dosage alprostadil (PGE1) cream (300 mcg) for the treatment of erectile dysfunction (ED). METHODS: A total of 43 ED patients were selected in the study based on the inclusion criteria. All of the patients signed informed consent forms and entered a 4-week open-label clinical study. A dosage of 300 mg PGE1 in 75 mg cream was applied intrameatally. RESULTS: The results showed that the primary efficacy (IIEF Q3 + Q4) reached 70.73% after application of the cream. The successful intercourse rate was 86.41%. Based on the GAQ (global assessment Question); 73.17% of the patients were satisfied with their sexual life. At the same time, all of the secondary criteria supported the primary efficacy results. Two patients withdrew during the study period. Six patients (14.63%) had urethral pain or penile redness, which were mostly mild and transient. CONCLUSIONS: With intrameatal low dosage (300 mcg PGE1) of the PGE1 cream can achieve an equivalent efficacy as that with the full dosage.

Adult↗