Differences In Patient Assessment Research Articles

Early Fractional Ablative Laser for Skin Cancer Excision Scars: A Randomized Split-Scar Study.

Fractional ablative laser resurfacing has been shown to improve the final cosmetic appearance of surgical scars, but optimal timing is unknown. To compare surgical scars treated with fractional carbon dioxide (CO 2 ) laser performed on Day 0 and Day 14. Prospective, randomized, split-scar, physician-blinded study of 30 surgical scars on the limbs. Scars halves received fractional CO 2 laser on either Day 0 or Day 14. Scar assessment at 6 months evaluated patient preference, physician modified Manchester Scar Scale (MMSS) score, and quantitative scar analysis on histology (fractal dimension [F D ] and lacunarity [L] analysis). There was no significant difference in patient assessment (54% preferred Day 0 side, 46% preferred Day 14 side, p = .58) or physician assessment (mean MMSS 8.4 for Day 0 vs 8.7 for Day 14, p = .28). Fractal dimensions were similar for both interventions (mean 1.778 for Day 0 vs 1.781 for Day 14, p = .80). Lacunarity was similar for both interventions (mean 0.368 for Day 0 vs 0.345 for Day 14, p = .44). Single-center study with wounds limited to limbs of skin Phototype I-II subjects; 4 of whom were lost to follow-up. Intraoperative CO 2 laser is noninferior to Day 14 laser resurfacing for surgical scar treatment.

Does wound eversion improve cosmetic outcome?: Results of a randomized, split-scar, comparative trial

Wound edge eversion has been hypothesized to improve aesthetic outcomes after cutaneous wound closure. Data supporting this assertion are sparse. We sought to determine if wound eversion, achieved with interrupted subcuticular sutures, improves aesthetic outcome compared with planar closures. We undertook a prospective, randomized, split-scar intervention in patients who underwent cutaneous surgery. Half of the wound was randomized to an everted or planar repair; the other side received the opposite one. At 3- and 6-month follow-up, both the patient and 2 blinded observers evaluated the wound using the Patient Observer Self-Assessment Scale (POSAS). The total observer POSAS score for the everted (13.59, 12.26) and planar (12.91, 12.98) sides did not differ significantly at 3 or 6 months, respectively. Similarly, there was not a significant difference in patient assessment between the everted (16.23, 12.84) and planar (15.07, 12.79) sides at 3 or 6 months, respectively. Finally, there was no significant difference between the 2 closure methods in terms of scar height or width at follow-up. This was a single-center trial, which used a validated but still subjective scar assessment instrument. Wound eversion was not significantly associated with improved overall scar assessments byblinded observers or patient assessment.

Influence of Gender on the Patient's Assessment of Restorations on the Upper Anterior Teeth.

The aim of this study was to assess the level of patients' satisfaction with appearance of maxillary anterior teeth restorations and to determine if there is a significant difference in patients' assessment of restoration appearance with regard to gender. Two hundred subjects evaluated the colour, anatomical shape and surface texture of maxillary anterior teeth restorations (composite fillings, acrylic faceted metal crowns, porcelain-fused-to-metal crowns and all-ceramic crowns) in comparison with adjacent natural teeth. The data were expressed in patients' average assessment scores for colour, anatomical shape and surface texture as well as overall patients' average assessment scores for every type of restoration and overall patients' average assessment scores for colour, anatomical shape and surface texture of all the restorations in general. Patients also assessed the general impression of their maxillary anterior teeth restorations and rated it as satisfactory or unsatisfactory. There was a statistically significant gender difference in patient assessment of colour and surface texture for composite fillings and the overall patient average assessment score for colour of all assessments (p <0.05). Women were more dissatisfied with the general impression of their restorations on the upper teeth than men (p >0.05). Only overall patients' average assessment score for composite restorations almost reached the level of significance (p = 0.069) on patients' general impression. Colour of the restorations and the composite material are significant factors which affect dental appearance of maxillary anterior teeth in patients.

Treatment of ankylosing spondylitis with biologics and targeted physical therapy

Biologics are highly effective in ankylosing spondylitis (AS). In this self-controlled study, we assessed the additive value of complex physiotherapy in decreasing chest pain and tenderness and improving respiratory function in AS patients treated with tumor necrosis factor α (TNF-α) inhibitors. The trial consisted of 2 parts. In study I, clinical data of AS patients with (n=55) or without biological therapy (n=20) were retrospectively analyzed and compared. Anthropometrical data, duration since diagnosis and patient assessment of disease activity, pain intensity, tender points, sacroiliac joint involvement determined by X-ray, functional condition, and physical activity level were recorded. Subjective, functional, and physical tests were performed. In study II, 10 voluntary patients (6 men and 4 women, age 52.4 ± 13.6 years) with definite AS and receiving anti-TNF therapy were recruited. It was a prospective, non-randomized physiotherapeutic trial. BASFI (Bath Ankylosing Spondylitis Functional Index), BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), modified Schober Index, occiput-to-wall distance, and fingertip-to-floor distance were evaluated. Forced vital capacity, forced 1-s expiratory volume, peak expiratory flow, and maximum voluntary ventilation were recorded. Furthermore, typical tender points were recorded. A targeted physiotherapy program was conducted twice a week for 12 weeks and all above parameters were recorded at baseline and after 12 weeks. Differences in patient assessment of disease activity (p=0.019) and pain intensity (p=0.017) were found in study I. Pain and tenderness of the thoracic spine were observed in both groups. Back pain without biologic therapy was slightly higher than other group. In study II, we found that patient assessment of disease activity and pain intensity significantly improved after the physical therapy program (p=0.002 and p<0.001). BASFI and BASDAI increased after treatment (p=0.004 and p<0.001). The finger-to-floor distance, chest expansion, and modified Schober index increased (p=0.008, p<0.001, and p=0.031, respectively). The respiratory functional parameters showed a tendency towards improvement. AS patients already receiving biological therapy may benefit from additional targeted physiotherapy. Physical therapy may be of important additive value in AS patients being treated with biological. The exercise program presented here showed an improvement in functional parameters as well as spine and chest mobility, thereby enhancing the favorable effects of biological therapy.

Motor follow-up of parkinsonian patients after deep-brain stimulation

The numerous published studies addressing parkinsonian patients’ motor follow-up after surgery for deep-brain stimulation of the subthalamic nucleus bring to the fore several methodological problems that we consider of major importance. Assessing motor function in these patients is a complex task. They must be preoperatively assessed with and without oral medication, and postoperatively assessed with and without oral medication and with the stimulators turned on and turned off, hence under four conditions MED OFF/STIM OFF, MED ON/STIM OFF, MED OFF/STIM ON, and MED ON/STIM ON. The four conditions combined in various ways offer scope for numerous comparisons yielding a wealth of information. At the same time, there are several problems in clinical practice, which suggest the need to reappraise the existing patient assessment protocols. The Core Assessment Program for Surgical Interventional Therapies in Parkinson’s disease (CAPSIT-PD) recommendations define MED ON as the motor state assessed after the patient takes the usual morning levodopa dose [1]. Because morning doses often vary from patient to patient, this definition introduces inherent interpatient variability that is hard to eliminate. The frequent changes in a patient’s morning dose after the intervention also lead to intrapatient variability. The variability in the morning dose makes it difficult to compare the motor benefits achieved by preoperative oral therapy and postoperative oral therapy and stimulation (MED ON vs. MED ON-STIM ON), a core comparison in the postoperative follow-up of parkinsonian patients after deep-brain stimulation. One way to render this comparison fully homogeneous would be to maintain oral therapy quantitatively unchanged. For example, a patient taking 100 mg of levodopa preoperatively would be assessed postoperatively while taking 100 mg even if they actually require a lower dose. This solution might nevertheless be only partly applicable given that parkinsonian patients in advanced stage of disease often take levodopa in large amounts, the preoperative morning dose often reaching 200 mg, an amount inducing supramaximal post-synaptic dopaminergic receptor stimulation. Using the same levodopa dose preoperatively and postoperatively under these conditions would obviously be meaningless insofar as the dopamine-receptor stimulation induced by a supramaximal levodopa dose could bring no further meaningful motor benefit. The difficulties encountered in clinical practice also reflect differences in patient assessment. Whereas some studies assess patients after they receive their usual morning dose [2, 3], others define MED ON as the motor state reached after patients take 150% of the usual morning dose [4–6]. Yet other studies refer to the best ON medication motor state [7]. Difficulties arise also in assessing patients in the OFF medication motor state. According to the CAPSIT-PD recommendations, patients reach the OFF medication motor state 12 h after dopaminergic withdrawal [1]. Although most studies follow this recommendation, some variability exists given that the time elapsing after withdrawing therapy ranges from 8 to 12 h [5], 10 to 12 h [2], to at least 12 h or exactly 12 h [4, 6, 7]. A 12-h interval seems an acceptable compromise that in patients with advanced disease who are fully G. Caranci (&) F. Lena N. Modugno S. Ruggieri P. Romanelli M. Manfredi Centre for Parkinson’s Disease, IRCCS Neuromed Institute, via Atinense 18, 86077 Pozzilli, Isernia, Italy e-mail: giovannicaranci@tiscali.it

Proper and common names: A double dissociation

Proper name anomia and proper name sparing are unusual disorders characterized by a selective inability, or sparing, to retrieve proper names as opposed to common names. They may eventually demonstrate that these two categories of names are independently processed in the brain at the semantic or lexical/orthographic level. Yet, differences in patient assessment make comparison between cases difficult to interpret and raise alternative explanations to those dissociations, such as that they may be accounted for by the level of difficulty of test stimuli.We describe two individuals, of identical age, gender and cultural background, with a complementary pattern of impairment of name retrieval following a left hemisphere stroke. ACB had an aphasic disorder with impaired naming, sparing proper names, while JFJ had normal language abilities and semantic knowledge about people, but a marked anomia for people's names. Patients were studied using the same material, thus overcoming methodological constraints pointed to previous work. These cases provide evidence of a double dissociation between proper and common names at the lexical access level. In addition, JFJ had a normal ability to retrieve historical and religious names suggesting that either these names are less difficult to retrieve or that they may segregate within the proper name lexicon.Lesion of the left temporal pole was also dissociated. It was damaged in ACB but spared in JFJ, contradicting its crucial role in proper name processing.

Nursing and infection-control issues during high-frequency oscillatory ventilation

To review the specific nursing and infection-control issues that arise during the care of patients receiving high-frequency oscillatory ventilation (HFOV). Published articles, governmental guidelines, and hospital procedures and practices. Nurses, respiratory therapists, and other clinicians caring for patients receiving HFOV need to be aware of specific differences in patient assessment, including close observation for symmetric chest-wall vibrations. In addition, management of sedation with or without neuromuscular blockade and effective communication with the patients are essential nursing skills needed with the use of HFOV. From an infection-control standpoint, HFOV is considered a high-risk respiratory procedure because of the inability to effectively filter all respiratory secretions. Appropriate infection-control precautions, including patient location and use of personal protective equipment, need to be considered when implementing HFOV in the intensive care unit. Important infection-control and nursing issues exist that are specific to the use of HFOV. These issues should be addressed with appropriate staff education before the implementation of HFOV in an intensive care unit.

A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss

Background To pical minoxidil solution 2% stimulates new hair growth and helps stop the loss of hair in men with androgenetic alopecia and women with female pattern hair loss. Results can be variable, and historic experience suggests that higher concentrations of topical minoxidil may enhance efficacy. Objective The purpose of this 48-week, double-blind, placebo-controlled, randomized, multicenter trial was to compare the efficacy and safety of 5% topical minoxidil with 2% topical minoxidil and placebo in the treatment of female pattern hair loss. Methods A total of 381 women (18-49 years old) with female pattern hair loss applied 5% topical minoxidil solution (n = 153), 2% topical minoxidil solution (n = 154), or placebo (vehicle for 5% solution; n = 74) twice daily. Primary efficacy variables were change in nonvellus hair count at week 48, and patient and investigator assessments of change in hair growth/scalp coverage at week 48. Results After 48 weeks of therapy, 5% topical minoxidil was superior to placebo for each of the 3 primary efficacy measures. The 2% topical minoxidil group demonstrated superiority over placebo for hair count and investigator assessment of hair growth/scalp coverage at week 48; differences in patient assessment of hair growth at week 48 were not significantly different from placebo. The 5% topical minoxidil group demonstrated statistical superiority over the 2% topical minoxidil group in the patient assessment of treatment benefit at week 48. Both 5% and 2% topical minoxidil helped improve psychosocial perceptions of hair loss in women with female pattern hair loss. An increased occurrence of pruritus, local irritation, and hypertrichosis was observed with 5% topical minoxidil versus 2% topical minoxidil and placebo. Conclusion In this 48-week study of 381 women with female pattern hair loss, 5% topical minoxidil was superior to placebo on each of the 3 primary efficacy end points: promoting hair growth as measured by change in nonvellus hair count and patient/investigator assessments of hair growth and scalp coverage. Application of 2% topical minoxidil was superior to placebo for assessments of nonvellus hair counts and investigator assessment of hair growth/scalp coverage at week 48; differences in patient assessment of hair growth at week 48 were not significantly different from placebo. At week 48, the 5% topical minoxidil group demonstrated statistical superiority over the 2% topical minoxidil group in the patient assessment of treatment benefit. Both concentrations of topical minoxidil were well tolerated by the women in this trial without evidence of systemic adverse effects. With the introduction of numerous herbal remedies for hair loss, of which most have not been tested in randomized, double-blind, placebo-controlled trials, it is important to describe well-controlled trials that demonstrate the efficacy and safety of topical drugs.

Repair of the radial free flap donor site with full or partial thickness skin grafts: A prospective randomised controlled trial

The radial forearm free flap has become the mainstay in the reconstruction of soft tissue defects following ablative resection in the oral cavity. The method of repair of the associated forearm tissue defect has been the subject of considerable debate. The options range from direct closure, to local soft tissue flaps or skin graft repair. Larger defects usually require a skin graft and we have routinely used partial thickness skin. An audit of our complication rate led to the consideration of whether a full thickness repair would reduce the morbidity. We randomly allocated successive patients to receive full or partial thickness skin graft repair of the radial donor site in a consecutive series of 68 patients over an 18-month period. Sixty-four patients completed the initial assessment period of wound healing. Thirty seven patients completed a questionnaire at one year to subjectively assess the aesthetic appearance of the forearm wound and the skin graft donor site. They were also assessed for pain at both sites. The partial thickness donor site required significantly more redressings. There was no significant difference between the two groups in graft take or number of re-dressings at the recipient site. There was no significant difference in patient assessment of aesthetic appearance or pain in either the forearm recipient site or the skin graft donor site. Provided that an adequate graft is taken, full thickness and partial thickness skin grafts have the same short-term and long-term outcomes in the repair of the radial free flap donor site.

The Johnson antishear device and standard shin pad in the isokinetic assessment of the knee.

Isokinetic training and assessment of the knee joint has been the mainstay of rehabilitation, especially in patients with anterior cruciate ligament deficiency. Besides the original shin pad used, the antishear device was introduced by Johnson in 1982. This device has been shown biomechanically to prevent excessive anterior translation of force on the tibia during training. However, there is a need to compare the antishear device and the standard shin pad in the isokinetic assessment. Hence, the major objective of this study is to define, if any, the difference in patient assessment between the new double pad device and the old single shin pad. Ten subjects with no previous history of injury on either knee were tested with the Cybex Isokinetic Dynamometer. There were four men and six women and the mean age was 25.2 years. They were randomized into different test sequences with different shin pads at different speeds. Correlation and paired t tests (P) were performed to find out the correlation and difference between the two devices. There was significant difference in performance assessment between the two devices in knee extension (P < 0.05) but no significant difference in knee flexion (P > 0.05). There was also a high correlation (r > 0.75) between the two devices. It is concluded that because of the significant difference of data generated between the two devices, it is important to select one single device with each patient during a series of testings.