IN OFFICE Research Articles

Botulinum Toxin Injection for Retrograde Cricopharyngeal Dysfunction: A Prospective Cohort Study.

Retrograde Cricopharyngeal Dysfunction (RCPD) is treated by botulinum toxin (BTX) injection into the cricopharyngeus. This prospective study compares the effectiveness and side effects of operating room (OR) and in-office (IO) injections. Patients over 18 years of age with inability to burp, abdominal, thoracic, or cervical gurgling sounds, bloating, and excessive flatulence were diagnosed with RCPD and included in the study. Injections were performed in the OR (80U) or IO (30U) by the senior author. An RCPD questionnaire quantifying major and minor symptoms on a Likert scale, Eating Assessment Tool-10 (EAT-10), and Generalized Anxiety Score-7 (GAD-7), were completed preinjection; at 1, 2, and 3 weeks; and 3 months postoperatively. Linear mixed models were used to analyze effects of BTX injection on RCPD symptoms, the EAT-10, and the GAD-7. 108 (55 M/53F) patients completed the pretreatment survey, 53 (31 OR vs. 22 IO) completed the 3-week follow-up, and 36 (22 OR vs. 14 IO) completed the 3-month questionnaire. Average posttreatment RCPD scores were significantly lower in both groups at 3 weeks and 3 months (p < 0.0001), There was no difference between IO or OR (p = 0.4924). GAD-7 scores were significantly lower in both groups at week 3 (p = 0.0018) and month 3 (p = 0.0012). Postinjection EAT-10 scores were significantly higher in OR compared with IO (p = 0.0379). OR and IO injections are equally effective in the treatment of RCPD. Postinjection dysphagia is more severe after the OR injections which may be related to higher doses of BTX used. General anxiety levels decrease with treatment. 2 Laryngoscope, 134:4614-4619, 2024.

Long-term remote monitoring vs. in-office monitoring of pacemakers: a systematic review and meta-analysis

Abstract Background Remote monitoring (RM) is increasingly recognised as the standard of care for patients with cardiac implantable electronic devices (CIEDs) according to current practice guidelines, particularly in pacemaker usage which represents the majority of CIEDs. However, there is insufficient evidence to assess the long-term safety of RM compared to in-office (IO) monitoring of pacemakers over extended periods, as well as its effectiveness in reducing in-office visits for device reprogramming. Purpose We aimed to perform a meta-analysis to compare RM and IO monitoring of pacemakers with at least 12 months of follow-up. Methods We systematically systematic search EMBASE, PubMed/MEDLINE, Cochrane, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing remote monitoring (RM) and in-office (IO) monitoring of pacemakers, with a focus on outcomes related to (1) all-cause mortality, (2) stroke, and (3) hospitalizations due to cardiovascular and device-related adverse events. Heterogeneity was assessed using I² statistics, and outcomes with high heterogeneity were analysed using a random-effects model. Results Six RCTs with a total of 3,059 patients were included in the meta-analysis. Of these, 1,495 patients (48.87%) underwent RM. In-office number of follow-ups per year was not significantly different between groups (OR -0.71; 95% CI -1.45 - 0.03; p = 0.06; I² = 99%; Fig. 1a) but tended to favour the RM group. No significant differences were found between RM and IO monitoring in terms of all-cause mortality (OR 1.14; 95% CI 0.83 - 1.55; p = 0.42; I² = 0%; Fig. 1b), stroke (OR 0.82; 95% CI 0.37 - 2.19; p = 0.82; I² = 38%; Fig. 2a), or hospitalizations for cardiovascular or device-related adverse events (OR 0.96; 95% CI 0.72 - 1.28; p = 0.78; I² = 0%. Fig. 2b). Conclusion This is the first meta-analysis comparing RM and IO monitoring for long-term pacemaker usage. Our results suggest that the number of follow-ups tended to be fewer in the RM group, and both monitoring methods appear to be similar in terms of all-cause death, stroke, and hospitalizations for cardiovascular or device-related adverse events.

Long-Term Remote vs. Conventional Monitoring of Pacemakers: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Remote monitoring (RM) is the standard of care for patients with cardiac implantable electronic devices (CIEDs), particularly pacemakers. However, the long-term outcomes of RM versus conventional monitoring (CM) of pacemakers and its effectiveness in reducing in-office (IO) visits for device reprogramming require elucidation. This systematic review and meta-analysis aimed to compare the RM and CM of pacemakers over a long-term follow-up. We systematically searched the PubMed/MEDLINE, Embase, Cochrane, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing RM and CM of pacemakers with at least 12 months of follow-up. Binary endpoints were pooled with risk ratios (RRs), whereas continuous outcomes were computed using mean differences (MDs) or standardized MDs (SMDs). Heterogeneity was assessed using I2 statistics. Among the eight included RCTs, 2159 (48.9%) of 4063 patients underwent RM. Follow-up periods ranged from 12 to 24 months. There were no significant between-group differences in all-cause mortality (RR=1.19; 95% confidence interval [CI], 0.90-1.57; p=0.22; I2=0%), stroke (RR=0.90; 95% CI, 0.43-1.91; p=0.79; I2=23%), hospitalizations for cardiovascular and/or device-related adverse events (RR=0.95; 95% CI, 0.75-1.21; p=0.70; I2=0%), and quality of life (SMD=-0.06; 95% CI, -0.22 to 0.10; p=0.473; I2=0%). RM was associated with fewer IO visits/patient/year (MD=0.98; 95% CI, -1.64 to -0.33; p=0.08; I2=98%) and higher rates of atrial tachyarrhythmia (ATA) detection (RR=1.22; 95% CI, 1.01-1.48; p=0.04; I2=0%) than was CM. This meta-analysis suggests that RM of pacemakers leads to higher rates of ATA detection and fewer IO visits/patient/year, without compromising patient safety.

Lateral Transcervical In-office Botulinum Toxin Injection for Retrograde Cricopharyngeal Dysfunction.

Operating room (OR) injection of botulinum toxin (BTX) injection is effective in the management of retrograde cricopharyngeal dysfunction (RCPD). This study aims to analyze the efficacy and safety of in-office (IO) 30 Unit BTX injection into the cricopharyngeus via lateral transcervical approach. A retrospective chart review of patients who underwent BTX injection either in the OR or IO for RCPD was performed. Postoperative success, defined by patient-reported complete or near complete resolution of symptoms, side effects, and complication rates of each group was determined and compared. To determine the learning curve of IO injections, success rates of the injections performed in the early and late 6 months were compared. Chi-square test was used for determining the statistical significance. Overall, 78 injections (37 IO and 41 OR) for RCPD were performed by the senior author. The success rate of OR injections (90.2%) is significantly higher than IO injections (64.9%) at the first-month follow-up (p = 0.022). No significant difference was found in the side effect rates. Success and side effect rates were also similar in early and late injections (p > 0.05). IO lateral transcervical BTX injection for RCPD is a safe method that does not require general or topical anesthesia. While the side effects are similar and IO injections have many advantages, the success rates are lower than OR injections. 3 Laryngoscope, 134:283-286, 2024.

MP74-15 COMPARISON OF REMOTE MONITORING (HOME) VERSUS IN OFFICE UROFLOWS IN WOMEN: ACCURACY AND CLINICAL RELEVANCE

You have accessJournal of UrologyCME1 Apr 2023MP74-15 COMPARISON OF REMOTE MONITORING (HOME) VERSUS IN OFFICE UROFLOWS IN WOMEN: ACCURACY AND CLINICAL RELEVANCE Michael Huaman, Yat Ching Fung, and Jerry Blaivas Michael HuamanMichael Huaman More articles by this author , Yat Ching FungYat Ching Fung More articles by this author , and Jerry BlaivasJerry Blaivas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Maximum uroflow (Qmax) is considered to be the gold standard to screen for bladder outlet obstruction (BOO) or detrusor underactivity (DU), but little attention has been paid to the accuracy of uroflowmeters. The aim of this study is to compare the accuracy of two different methods of measuring uroflow (Q). METHODS: This was a retrospective IRB approved, single-center study that compared Q measurements between office and home uroflows. Home Qs utilized a sound based mobile app+; office Qs were obtained by a gravimetric method.++ A database was searched for women who underwent Q on both UFMs as part of their diagnostic evaluation. There were no exclusion criteria. The extracted data is listed in the Table 1. Each UFM generated an automated printout of the Q data. The printout Qmax was compared to corrected Qmax, defined as the highest point of the Q curve that lasted ≥2 S. A 3 mL/S difference between the printout and corrected Qmax was considered clinically relevant. Q’s were excluded if no segment of the curve lasted ≥2 S or the curve did not begin and/or end at zero. RESULTS: (see Table 1). CONCLUSIONS: In this study, the printout, uncorrected best Qmax overestimated Qmax by 3-4 mL/S and overestimated the Qmax by ≥3 mL/S in 29-86% of women. Further, Q’s and voided volumes were higher in the office than at home. These findings, if corroborated, are highly relevant because those with a falsely elevated Qmax may be excluded from further workup for BOO or DU and those with falsely lower Q’s, recorded in the office, might relegate women to an unnecessary workup. The printout errors could be easily solved by changing the software Qmax criteria. The ability of remote UFMs to record multiple samples appears to allow for more accurate data analysis. +Home Uroflow (ProudP from Soundable Health); ++Office Uroflow (Urocap IV from Laborie Medical Technologies, Inc.). Source of Funding: Institute for Bladder and Prostate Research (IBPR) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1076 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Huaman More articles by this author Yat Ching Fung More articles by this author Jerry Blaivas More articles by this author Expand All Advertisement PDF downloadLoading ...

Effects of Microabrasion Prior to In-office Bleaching on Hydrogen Peroxide Permeability, Color Change, and Enamel Morphology.

This study evaluated hydrogen peroxide (HP) diffusion within the pulp chamber, as well as color change and the surface morphology of teeth subjected to various microabrasion (MA) protocols associated or not with in-office (IO) bleaching. Forty sound premolars were randomly divided into the following four groups (n=10): no treatment (NC); IO bleaching only; IO immediately after MA (IMA), and IO seven days after MA (7MA). After treatments, the HP concentration (μg/mL) within the pulp chamber was determined using ultraviolet-visible (UV-Vis) spectrophotometry. The color change (ΔE*) was evaluated using the digital spectrophotometer before and 1 week after bleaching. The surface morphology was evaluated by scanning electron microscope (SEM). Data from each test were submitted to one-way ANOVA and Tukey tests (α=0.05). All experimental groups exhibited higher HP concentrations compared to the NC group (p<0.00001). However, higher amounts of HP were observed for the IMA group compared to the IO and 7MA groups (p<0.00001). No significant difference in color change was observed among the groups (p<0.001). Pronounced grooves in enamel were found in the IMA and 7MA groups. However, enamel erosion areas were observed only in the 7MA group. The association between MA and IO bleaching could significantly affect the amount of HP inside the pulp chamber. Therefore, it is highly recommended to wait for 1 week after MA procedures before performing IO bleaching.

The Idea of Sport Agon as a Metaphor of Human Life in Thomas Hobbes’ Mechanistic Philosophy of Motion

Contemporary sport is a complex phenomenon with a rich multicultural historical tradition, its universal principles, such as peaceful and institutionalised competition included in the rules of individual fi tness professions, as well as ethos, ceremonial and ideology, are the work of many epochs and nations. The particular contribution of English culture to sport is well-known, from the promotion of its fi nal name (from the Old French desporte, which came to England in the 11th century with the Normans), through the promotion of physical education by eminent educators and philosophers such as John Locke, Herbert Spencer and Thomas Arnold, to the creation and dissemination of many sports, including football, rugby, tennis, cricket and golf. In the article, I refer to the philosophy of Thomas Hobbes, signifi cantly infl uencing the shape of modern concepts regarding natural rights, articulating, inter alia, the inalienable right of every human being to freely use his/her body to maintain health through physical activity. Hobbes based his anthropology on the mechanistic philosophy of motion, which he used to explain not only physical activity and functional fi tness of the body, but it also became a premise for the development of the psychology of human aff ects and desires, the culmination of which was the image of the sports race as a metaphor of human life. Hobbes did not limit himself to discussing in-offi ce deliberati, he was very active throughout his life, implementing the movement directive he proposed by performing sports, recreation, practicing preventive health treatments and taking numerous trips. The article is part of the history of ideas - it is a presentation of the concept of movement by the English modern philosopher Thomas Hobbes (1588-1679), supplemented with a new element in doxographic studies linking the mechanicism of the Leviathan author with the existential motif regarding the idea of the life as a sport competition.

Effectiveness of Whitening Strips Use Compared With Supervised Dental Bleaching: A Systematic Review and Meta-analysis.

Bleaching performed at home while under the supervision of a dentist provides greater color alteration compared with whitening strips when evaluated with a spectrophotometer, although the color alteration was undetectable by unaided human eyes. Objective: A systematic review and meta-analysis were performed to answer the following research question: Does the use of whitening strips (WS) lead to an equivalent color change compared with supervised dental bleaching in patients with permanent dentition?Methods: A search was performed on August 10, 2017 (updated on March 22, 2019), in PubMed, the Brazilian Library in Dentistry, Latin American and Caribbean Health Sciences Literature database, Cochrane Library, Scopus, Web of Science, and SIGLE, without restrictions regarding date or language. Abstracts from the International Association for Dental Research, unpublished and ongoing trial registries, dissertations, and theses were also searched. Only randomized clinical trials (parallel or split mouth) in patients with permanent dentition that compared WS with dentist-supervised dental bleaching performed at home (AH) or in office (IO) were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. A meta-analysis with subgroup analysis (low and high peroxide concentration) was conducted for color change ΔE* (spectrophotometer) and ΔSGU (shade guide units), risk and intensity of tooth sensitivity (TS), gingival irritation (GI), and patient satisfaction using a random effects model. Heterogeneity was assessed with the Cochrane Q test and I2 statistics. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was used to assess the quality of the evidence.Results: After the removal of duplicates, followed by title and abstract screening, 20 studies remained. Only two studies were considered to have a low RoB; 11 had a high RoB, and seven had an unclear RoB. For WS versus IO, data were not available for the meta-analysis. For WS versus AH bleaching, a significant difference in ΔE* favoring the AH group was observed (standardized mean difference [SMD] = -0.50, 95% confidence interval [CI] -0.79 to 0.21), but the risk (risk ratio = 0.78, 95% CI 0.65 to 0.93) and intensity of TS (SMD = -0.30, 95% CI -0.56 to -0.04) were lower in the WS group. Color change in ΔSGU, risk and intensity of GI, and patient satisfaction were not significantly different between groups (p>0.20). The quality of evidence for ΔE*, risk and intensity of TS, and intensity of GI were graded as moderate.Conclusion: Although the risk and intensity of TS were lower in the WS group, dentist-supervised at-home bleaching led to a better color change when measured with a spectrophotometer, although the color alteration was undetectable by unaided human eyes.

Role of Remote Monitoring in Detection of Atrial Arrhythmia, Stroke Reduction, and Use of Anticoagulation Therapy - A Systematic Review and Meta-Analysis.

The effect of remote monitoring (RM) in atrial arrhythmia detection, stroke reduction, and anticoagulation therapy remains unknown, particularly for patients with implantable or wearable cardiac devices. We performed a systematic review and meta-analysis to evaluate the role of RM in atrial arrhythmia detection, stroke reduction and anticoagulation therapeutic intervention. Online databases were queried to include randomized controlled trials comparing detection of atrial arrhythmia and stroke risk between patients undergoing RM and those receiving in-office (IO) follow-up. Outcomes and complications of RM-guided anticoagulation therapy and conventional therapy in patients with atrial fibrillation were also reviewed. A total of 16 studies were included. Compared with patients receiving IO follow-up, patients undergoing RM had a significantly higher detection rate of atrial arrhythmia (risk ratio [RR], 1.363; 95% confidence interval [CI], 1.147-1.619), and a lower risk of stroke (RR, 0.539; 95% CI, 0.301-0.936). The higher rate of atrial arrhythmia was only noted in patients with wearable devices (RR, 4.070; 95% CI, 2.408-6.877), and the lower risk of stroke was only noted in patients with cardiovascular implantable electronic devices (CIED) (RR, 0.513; 95% CI, 0.265-0.996). RM is effective for atrial arrhythmia detection in patients using wearable devices and for reducing the risk of stroke in patients with CIED.

Are combined bleaching techniques better than their sole application? A systematic review and meta-analysis.

A systematic review and meta-analysis were performed to answer this research question: "Does combined in-office (IO) and at-home (AH) bleaching produce improved color change and lower tooth sensitivity (TS) better than solely AH or IO bleaching in adults?" Randomized controlled trials in adults that compared combined versus sole application bleaching were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. Meta-analyses were conducted for color change in shade guide units (∆SGU) and with a spectrophotometer (∆E*), risk, and intensity of TS, using the random effects model. Heterogeneity was assessed with Cochran's Q test and I2 statistics. GRADE assessed the quality of the evidence. PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, SIGLE, IADR abstracts, unpublished, ongoing trial registries, dissertations, and theses were searched on August 28, 2017 (updated on January 29, 2019). Twelve studies remained. Two were considered to have low RoB. For combined vs. IO bleaching, no significant difference for ∆E*, ∆SGU, and risk of TS were observed; data were not available to analyze the intensity of TS. For combined vs. AH bleaching, no significant difference for ∆E*, ∆SGU, but lower TS to risk (RR 1.40, 95% 1.10 to 1.80) and intensity (MD 1.40, 95% CI 0.18 to 2.63) were detected for AH bleaching. Quality of evidence was graded as low or very low in all meta-analyses. Lower risk and intensity of TS was observed for the solely AH group without jeopardizing color change. However, more studies are still encouraged due to the low quality of evidence for most of the outcomes. If clinicians are to choose between combined or sole AH bleaching, the solely AH may be preferable; combined bleaching may potentiate the risk of TS without benefits in color change. For combined or sole IO bleaching, no important clinical difference in color change and risk of TS were detected; however, intensity of TS could not be compared due to lack of data. Further studies should be conducted due to the low/very low quality of the evidence.

In-office balloon sinus dilation versus medical therapy for recurrent acute rhinosinusitis: a randomized, placebo-controlled study.

A limited number of studies have demonstrated symptomatic improvement for recurrent acute rhinosinusitis (RARS) patients after endoscopic sinus surgery. In this randomized, controlled study we evaluated 24-week outcomes for balloon sinus dilation (BSD) performed in-office (IO) with medical management (MM) as compared with MM only for RARS patients. Adults diagnosed with RARS were randomized to groups with BSD plus MM (n = 29) or MM alone (n = 30). Patients who received MM alone also received a sham BSD-IO procedure to blind them to group assignment. Patients were followed to 48 weeks posttreatment. The primary outcome was the difference between arms in change in Chronic Sinusitis Survey (CSS) score from baseline to 24 weeks. Secondary endpoints included comparisons of Rhinosinusitis Disability Index (RSDI) score, medication usage, medical care visits, and sinus infections. Change in patient-reported quality of life (QOL), as measured by the CSS total score from baseline to 24 weeks, was significantly greater in the BSD plus MM group compared with the MM-only group (37.3 ± 24.4 [n = 26] vs 21.8 ± 29.0 [n = 27]; p = 0.0424). BSD plus MM proved superior to MM alone in enhancing QOL for RARS patients. BSD plus MM should be considered as a viable treatment option for properly diagnosed RARS patients.

Remote Monitoring of Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Clinical Outcomes

BackgroundRemote monitoring (RM) of implantable cardioverter-defibrillators (ICD) is an established technology integrated into clinical practice. One recent randomized controlled trial (RCT) and several large device database studies have demonstrated a powerful survival advantage for ICD patients undergoing RM compared with those receiving conventional in-office (IO) follow-up. ObjectivesThis study sought to conduct a systematic published data review and meta-analysis of RCTs comparing RM with IO follow-up. MethodsElectronic databases and reference lists were searched for RCTs reporting clinical outcomes in ICD patients who did or did not undergo RM. Data were extracted from 9 RCTs, including 6,469 patients, 3,496 of whom were randomized to RM and 2,973 to IO follow-up. ResultsIn the RCT setting, RM demonstrated clinical outcomes comparable with office follow-up in terms of all-cause mortality (odds ratio [OR]: 0.83; p = 0.285), cardiovascular mortality (OR: 0.66; p = 0.103), and hospitalization (OR: 0.83; p = 0.196). However, a reduction in all-cause mortality was noted in the 3 trials using home monitoring (OR: 0.65; p = 0.021) with daily verification of transmission. Although the odds of receiving any ICD shock were similar in RM and IO patients (OR: 1.05; p = 0.86), the odds of inappropriate shock were reduced in RM patients (OR: 0.55; p = 0.002). ConclusionsMeta-analysis of RCTs demonstrates that RM and IO follow-up showed comparable overall outcomes related to patient safety and survival, with a potential survival benefit in RCTs using daily transmission verification. RM benefits include more rapid clinical event detection and a reduction in inappropriate shocks.

Combined email and in office technology improves patient reported outcomes collection in standard orthopaedic care

s / Osteoarthritis and Cartilage 22 (2014) S57–S489 S191 327 COMBINED EMAIL AND IN OFFICE TECHNOLOGY IMPROVES PATIENT REPORTED OUTCOMES COLLECTION IN STANDARD ORTHOPAEDIC CARE X. Zhou, R. Karia, R. Iorio, J. Zuckerman, J. Slover, P. Band. NYU Langone Med. Ctr., Hosp. for Joint Diseases, New York, NY, United States Purpose: Patient reported outcomes (PRO) provide an important measure of clinical condition from the patient’s perspective. Recently, there has been increasing interest in the use of PRO scores during routine clinical practice, as the focus on quality and value-based healthcare continues to grow. However, the routine collection of PRO data without disrupting clinical workflow remains a challenge. This study evaluates the capture rates of PRO data as part of standard orthopaedic care, collected electronically via either e-mail or in the office setting. Methods: An electronic PRO collection system was developed at a large, tertiary, academic medical center in 2012, designed to routinely collect PRO data as part of standard care. An e-mail distribution function was built to send a secure HIPPA compliant e-mail to patients three days before their visit. A PRO questionnaire link is embedded in the e-mail allowing completion at home prior to the visit. Patients who do not complete via e-mail receive a touchscreen in the office to complete the PRO questionnaire prior to their clinical exam. PRO scores are calculated in real-time, integrated into the patient’s EMR, and made available to the evaluating physician for clinical decisionmaking. Results: Between May, 1st, 2012 and April 30, 2013, PRO questionnaires were completed for 19218 of 26548 total patient visits to 21 adult reconstruction or sports medicine practices. Overall, completion rates were 79% and 68%. Office staff collected email addresses for 48% of total patient visits, and consequently, 64% (12306 of 19218) of the completed PRO questionnaires were done in the office versus 36% (6912 of 19218) via email. The completion rate via email was 41% in adult reconstruction and 32% in sports medicine. When the email completion rate is calculated based on patients for whom office staff obtained email addresses, completion rates via email at home are 55% in adult reconstruction and 53% in sports medicine. Elderly patients ( 65 years) had a higher e-mail completion rate (57%) than younger ( 50 mm) based on ACR Classification criteria were enrolled. A radiological Kellgren-Lawrence index 1–2 was required. Correlation between indices was estimated with Spearman’s Rho. A General Linear Model (GLM) was used to estimate the effect size between indices. Reliability analysis was assessed finally using coefficients of IntraClass Correlation. Results: 221 patients were enrolled and completed WOMAC and MDHAQ-RAPID3 questionnaires during the period 2009–2013. RAPID 3 mean value was 5.7 1.3 in patients with knee OA. Kurtosis 0.287 0.211, skewness 0.61 0.12. The ceiling/floor effect, % of responses that are coded at the maximum/minimum value, ranged <10%. WOMAC total score was 57.2 13.4. Spearman’s rho index was 0.84. Using a General Linear Model (GLM) to estimate the proportion of variation of WOMAC explained by RAPID 3 we found an effect size of 0.82 (p < 0.01). Coefficients of IntraClass Correlation between mean values of WOMAC and RAPID3 was 0.812, F test with P 1⁄4 0.001. Conclusion: RAPID3 scores provide similar quantitative information to WOMAC in patients with knee osteoarthritis.

Home MonitoringTM technology and integrated follow-up care of ICD patients

Objective Increasing utilization rates of implantable cardioverter-defi brillators (ICDs) tend to overburden follow-up resources at the implanting electrophysiological centres (ECs). Remote monitoring technology allows physicians from diff erent institutions to simultaneously review ICD data of shared patients. We studied if an integrated follow-up care involving ECs and general cardiologists (GCs) may reduce the frequency of in-offi ce follow-ups at ECs by using remote monitoring data to identify routine checks that may be conducted at GCs.Methods and results The analysis included 109 patients (aged 63 ± 11 years, 84.4% male) followed for a cumulative study duration of 155 patient-years. The patients underwent 436 in-offi ce controls after hospital discharge: 143 (33%) at two ECs and 293 (67%) at two GCs (each cooperating with one EC). The mean duration of in-offi ce follow-up sessions was 13.7 min (EC) and 10.3 min (GC). The average distance between patients’ homes and follow-up sites was 31.6 km (EC) vs. 16.2 km (GC). Investigators considered a follow-up to be of ‘high or medium’ importance in 78% (EC) vs. 45% (GC) of all in-offi ce follow-ups. At one EC, the integrated follow-up care concept appeared highly successful, with 97% of follow-ups transferred to the corresponding GC and, on average, 103.8 km shorter patient trips per follow-up.Conclusions Integrated follow-up care guided by remote monitoring allows to direct the more signifi cant follow-ups towards ECs and routine follow-ups towards GCs. This concept may contribute to the needed adaptations of the health-care system to the rising numbers of patients with implanted devices.

In-offi ce Clinical Assessment and Treatment of Swallowing Disorders due to Cerebrovascular Disease

In-offi ce Clinical Assessment and Treatment of Swallowing Disorders due to Cerebrovascular Disease

A STUDY ON METHOD OF EVALUATING FIRE SAFETY IN OFFICE FACILITIES

Authors discussed on a method to estimate the fire damage area in existing office buildings by the beforehand questionnaire sheet survey. A questionnaire sheet was developed taking into consideration the score pointed not only the substantiality degree of the hardware factors, but also the substantiality degree of the software factors. A survey was conducted on experimentally 185 existing office buildings with the above-mentioned questionnaire sheet. As a conclusion, authors made clear what might calculate the fire safety index to be able to perform comparison of the fire safety performance between the building easily with the above-mentioned questionnaire sheet, and what might estimate the fire damage area before firebreak.

Making a Bad Law Worse

IN ITS FINAL DAYS IN OFFICE, Jean Chretien government had some good--or at least provocatively interesting--ideas about justice. It proposed to legalise same-sex marriage, and it offered plan to partially decriminalise use of marijuana. It also had one very bad idea: Bill C-20, proposal to amend and strengthen existing law (See. 163.1 of Criminal Code). The centrepiece of Bill C-20 is disturbing move to eliminate defence of artistic or an educational, scientific or medical purpose against charge of pornography, and replace it with defence of serving public good. Then, having abolished artistic merit drafters of bill further proposed that written material dominant characteristic of which is description, for sexual purpose, of sexual activity with person under age of eighteen that would be an offence under Criminal Code should also be made clime. (1) Though passage of Bill C-20 was interrupted by prorogation of Parliament in November 2003, new government of Prime Minister Paul Martin has option of resuming consideration of this legislative scheme. To understand how and why Parliament of Canada arrived at startling idea of partially striking down longstanding right of artists to freedom of speech and expression requires bit of history. (2) Ever since its legislative passage in summer 1993, more than decade ago, Sec. 163.1 of Criminal Code (a supplement to Sec. 163, law against obscenity) was conceptually inchoate. Yet, original notion for law, as drafted by Ministry of Justice, was reasonably coherent. Tee core idea was that any sexual representation of actual children that was produced through commission of sexual crime against those children should be prohibited. For example, it is illegal for an adult to engage in sexual touching of children under age of fourteen or to counsel or induce sexual touching of such children. It's also illegal for adults to engage in sex with persons under age of eighteen with whom they are in relation of authority or trust (such as relationships between teachers and students under eighteen), or to provide an inducement for young people under eighteen to engage in sex with adults (as in prostitutional circumstances). Since such acts are crimes against children and young people, reasoning went, representations of those acts perpetuated and extended harm caused by original violation. The new law also contained one novel feature: while obscenity law criminalised making, distribution and sale of obscene materials, law also criminalised mere possession of pornography, first law in Canadian jurisprudence to Criminalise simple possession of expressive materials. Unfortunately, law passed by Parliament in 1993 was far different from one envisaged by its drafters. Once bill reached Commons, it was drastically expanded by legislators, and law that was hastily passed in June 1993 was, in our view, constitutionally overbroad. The term means, in legal circles, that law captures activities and materials that are protected by Constitution and that should not be criminalised. The overbreadth of law is found in law's definition of pornography. In Section 163.1, child pornography means a photographic, film, video or other visual representation ... that shows person who is or is depicted as being under age of 18 and is engaged in or is depicted as engaged in explicit sexual activity. As well, includes representations the dominant characteristic of which is depiction, for sexual purpose, of sexual organ or anal region of person under age of 18 years. Finally, also includes written material or visual representation that advocates or counsels sexual activity with person under age of 18 years that would be crime under Criminal Code. …

CURRENT DIAGNOSTICS IN OFFICE PRACTICE Use of ultrasound in the head and neck

CURRENT DIAGNOSTICS IN OFFICE PRACTICE Use of ultrasound in the head and neck

Implementation of Computerized Clinical Documentation

Transition from a paper-driven system to a computerized clinical record is one of the most significant performance improvement activities in which any home health care organization may embark. Implementation of computerized documentation is a change that will impact virlually every aspect of operations within the organization. Although selection of hardware and sof tware is critical, the ultimate success of the project is dependent upon the commitment and effort of the people within the organization. This article will focus on one home care organization's experience implementing laptop technology. The results of this performance improvement activity include increased productivity of both in-of fice and field staff, decreased aggregate visit costs, and continued staff and patient satisfaction.

ADDRESSING HIV INFECTION IN OFFICE PRACTICE: Assessing Risk, Counseling, and Testing

ADDRESSING HIV INFECTION IN OFFICE PRACTICE: Assessing Risk, Counseling, and Testing