Reduce Patient Discomfort Research Articles

Sa1420 A Randomized Control Study of Audio Versus Visual Distraction to Reduce Patient Discomfort During Colonoscopy

Colonoscopy can cause discomfort and anxiety in patients who undergo the procedure. Heavy sedation as premedication can lead to complications in the elderly and those with co-morbidities. This has led to an interest in investigating the use of audio-visual distraction during the procedure. Our aim was to compare effects of audio versus visual distraction in reducing discomfort during colonoscopy.

Sa1421 Effect of Functional Relaxation on Patients Undergoing Colonoscopy: A Prospective Randomized Controlled Trial

Sa1421 Effect of Functional Relaxation on Patients Undergoing Colonoscopy: A Prospective Randomized Controlled Trial

Effectiveness of the Instructional Program on Physical and Psychological Status of Patients Undergoing Upper Gastrointestinal Endoscopy at Baghdad Teaching Hospitals

Objective: The present study aims to investigate the effectiveness of instructional program on the physical and psychological status of patients undergoing upper gastrointestinal endoscopy. Methodology: A quasi-experimental study was conducted in the outpatients and medical unite for the Gastroenterology and Herpetology unit in Baghdad teaching hospital and Al-Kindy teaching hospital Imamein Kadhimein Medical City for the period of the 5th of January 2014 to 17th August 2014. A non-probability sample was selected and composed of 100 patients divided into (50 patients within the study group who received the instructional program about upper gastrointestinal endoscopy and 50 patients within the control group were not exposed to the instructional program the instructional program was developed by the researcher and consisted of the information domain and trained domain and giving at least 7 day before the endoscopy procedure. A questionnaire was prepared for evaluating of patient physical status (through measuring the intensity of pain during the procedure by visual analogue scale and patient discomfort by (retching, attempt grabs the endoscope, body movement and moaning) and measuring the pulse rate and oxygen saturation blood pressure) during the procedure. While evaluating the psychological status (through measuring (state and trait anxiety) before and after the procedure. Identified validity of the questionnaire and instructional program by a panel of 28 experts, and identified the reliability of the search tool by adoption of a pilot study. Data were analyzed using descriptive statistics and inferential statistics. Results: The results of the study in regards of physical status (measurement of the pain intensity) there is a high significant difference between the study group and the control group, while the measurement of the discomfort also a highly statistically significant were founded between the study and the control group related retching, attempt grab the endoscopy, the movement of the patient's body and moaning except retching were no statistical observed. In addition the study revealed statistically significant between the study and control groups when measuring the pulse rate and oxygen saturation except measuring blood pressure As for the psychological status (anxiety state) There are no significant differences between the study and the control groups during the pre-test, but there are highly statistically significant between the each group during the post-test, while ( anxiety trait) no statistical significance between the each group during the pretest, post-test. Conclusion: The study concluded that there is a positive effect of instructional program implementing on physical and psychological status of patients undergoing upper gastrointestinal endoscopy in Baghdad teaching hospitals. Recommendations: The study recommended to circulate the pamphlet that prepared by the researcher for upper gastrointestinal endoscopy units in Baghdad teaching hospitals affiliated to the Ministry of Health, which serves as a guide for patients to comply with all instructions to reduce patient discomfort during endoscopy procedure and also reduce anxiety.

Electromagnetic guided bedside or endoscopic placement of nasoenteral feeding tubes in surgical patients (CORE trial): study protocol for a randomized controlled trial.

BackgroundGastroparesis is common in surgical patients and frequently leads to the need for enteral tube feeding. Nasoenteral feeding tubes are usually placed endoscopically by gastroenterologists, but this procedure is relatively cumbersome for patients and labor-intensive for hospital staff. Electromagnetic (EM) guided bedside placement of nasoenteral feeding tubes by nurses may reduce patient discomfort, workload and costs, but randomized studies are lacking, especially in surgical patients. We hypothesize that EM guided bedside placement of nasoenteral feeding tubes is at least as effective as endoscopic placement in surgical patients, at lower costs.Methods/DesignThe CORE trial is an investigator-initiated, parallel-group, pragmatic, multicenter randomized controlled non-inferiority trial. A total of 154 patients admitted to gastrointestinal surgical wards in five hospitals, requiring nasoenteral feeding, will be randomly allocated to undergo EM guided or endoscopic nasoenteral feeding tube placement. Primary outcome is reinsertion of the feeding tube, defined as the insertion of an endoscope or tube in the nose/mouth and esophagus for (re)placement of the feeding tube (e.g. after failed initial placement or dislodgement or blockage of the tube). Secondary outcomes include patient-reported outcomes, costs and tube (placement) related complications.DiscussionThe CORE trial is designed to generate evidence on the effectiveness of EM guided placement of nasoenteral feeding tubes in surgical patients and the impact on costs as compared to endoscopic placement. The trial potentially offers a strong argument for wider implementation of this technique as method of choice for placement of nasoenteral feeding tubes.Trial registrationDutch Trial Register: NTR4420, date registered 5-feb-2014Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0633-1) contains supplementary material, which is available to authorized users.

0549: Complications of repeat percutaneous mitral valvuloplasty

Percutaneous mitral valvuloplasty (PMV) has emerged as the procedure of choice in treatment of mitral stenosis and has proved effectiveness in cases of mitral restenosis after surgical commissurotomy Compared with surgery, PMV is associated with shorter hospital stays, reduced patient discomfort, and significantly lower costs. However, it is unknown whether patients who developed symptomatic mitral restenosis after PMV may benefit from repeat PMV (re-PMV) with safety. This study was designed to evaluate the occurrence rate and the predictive factors for severe complications following re-PMV. Retrospective study from a series of 40 procedures of re-PMV with the Inoue balloon at 8±4 years after prior procedure, performed between 1996 and 2011. A clinical and ultrasound follow-up was achieved in 31 patients with a mean follow-up period of 43±26 months. The mean age of patients was 43±11 years [23, 63]. 87,5% of the population being female (5 men and 35 women). The immediate procedural success was achieved in 31 patients (77.5%). A severe mitral regurgitation (MR) was observed in 3 patients (7.5%). A cerebrovascular stroke occurred in 1 patient (2.5%). No procedure-related death or cardiac tamponade were noted. Only a left atrial area ≤25cm ² was linked to high risk of severe MR. At long-term, mitral restenosis was observed in 13 patients (42%) at 53±30 months [9; 128] after re-PMV, 2 patients presented thromboembolic events (6%) and no death. Only the male had been identified as a predictor of restenosis The feasibility of re – PMV with a relatively high procedural success rate and an acceptable complication profile makes it an appealing therapeutic strategy for patients with recurrent valve stenosis. The improved experience of our medical teams, and the systematic use of transoesophageal echocardiography to detect thrombi explain the low incidence of the complications of re-PMV in our study.

Multiband mucosectomy for advanced dysplastic lesions in the upper digestive tract.

Endoscopic resection (ER) is at present an accepted treatment for superficial gastrointestinal neoplasia. ER provides similar efficacy to surgery; however, it is minimally invasive and less expensive. Endoscopic mucosal resection (EMR) is superior to biopsy for diagnosing advanced dysplasia and can change the diagnostic grade and the management. Several EMR techniques have been described that are alternatively used dependent upon the endoscopist personal experience, the anatomic conditions and the endoscopic appearance of the lesion to be resected. The literature suggests that EMR offers comparable outcomes to surgery for selected indications. EMR techniques using a cap fitted endoscope and EMR using a ligation device [multiband mucosectomy (MBM)] are the most frequently use. MBM technique does not require submucosal injection as with the endoscopic resection-cap technique, multiple resections can be performed with the same snare, pre-looping the endoscopic resection-snare in the ridge of the cap is not necessary, MBM does not require withdrawal of the endoscope between resections and up to six consecutive resections can be performed. This reduces the time and cost required for the procedure, while also reducing patient discomfort. Despite the increasing popularity of MBM, data on the safety and efficacy of this technique in upper gastrointestinal lesions with advanced dysplasia, defined as those lesions that have high-grade dysplasia or early cancer, is limited.

Current concepts and future developments of corneal cross-linking.

The introduction of corneal cross-linking (CXL) has changed the landscape of treatment and management of keratoconus and ectasia after refractive surgery. Previously, treatment options provided only temporary visual rehabilitation without limiting disease progression. Keratoconus and ectasia resulted in significant vision-related reduction in quality of life and a substantial lifetime economic burden, with up to 20% of keratoconus cases resulting in eventual corneal transplantation [1]. CXL was introduced as the first therapeutic option for keratoconus aimed at stiffening the cornea in order to treat the underlying stromal instability. From the time that the first reports of the clinical application of cross-linking in the cornea were published in 2003 [2], CXL has rapidly been adopted as a standard therapy for treatment of progressive keratoconus in much of the world [3–5]. The potential for early intervention with corneal cross-linking before visual function has been compromised has resulted in a shift in the way we think about corneal biomechanics and has reawakened interest in the early diagnosis of ectasia. In this issue, J. Steinberg et al. report two new parameters to detect biomechanical changes in the keratoconic cornea after CXL using in vivo corneal visualization Scheimpflug technology. Research in the area of corneal biomechanics has the potential to enable earlier diagnosis of patients in need of CXL and better analysis of the effects of the procedure. While many questions remain unanswered, the understanding of the photochemical mechanisms that result in the formation of cross-links in the cornea has grown exponentially in the last decade. Improved scientific understanding of the mechanisms of CXL has driven clinical research aimed at optimizing CXL for better efficiency and efficacy [6]. In this issue, A. C. da Paz et al. present a critical review of known and as yet undetermined effects of CXL on corneal structure, biomechanics, and functional aspects. J. Antoun et al. examine patient characteristics that contribute to cross-linking failure to stabilize keratometry and examine the effect of repeat treatments on eyes that have continued to progress after primary CXL. The remaining contributions to the special issue explore modifications to the conventional protocol that incorporate new technology, such as transepithelial riboflavin formulations designed to improve patient comfort (S. Taneri et al.) and higher irradiance and pulsed UVA delivery aimed at improving procedure speed and photon efficiency (C. Mazzotta et al.). CXL combination procedures targeted at maximizing visual outcomes through the addition of simultaneous intracorneal ring implantation (P. Studeny et al.) or subsequent phakic toric implantable collamer lens insertion (R. Antonios et al.) are also discussed. Together, the papers in this special issue describe the next generation of corneal cross-linking. The contributors explore the potential to maximize CXL efficacy, provide equivalent or greater treatment effect in shorter total treatment times, reduce patient discomfort and speed visual recovery, and offer both stabilization and functional visual improvement through CXL combination procedures. Suphi Taneri Elias Jarade John A. Kanellopoulos David Muller

104. Assessment of distal compound muscle action potential duration (DCMAPD) in paediatric chronic inflammatory demyelinating polyneuropathy (CIDP)

To evaluate if duration of distal compound muscle action potential duration (DCMAPD) could represent a sensitive parameter in clinical practice to add to established electrophysiological diagnostic criteria in paediatric chronic inflammatory demyelinating polyneuropathy (CIDP) and its rule in patient’s follow-up. We retrospectively reviewed records of 8 children affected by CIDP (6/8 possible CIDP, 2/8 confirmed CIDP) according to established diagnostic criteria of the 88th ENMC International Workshop (2000), before consideration of DCMAPD prolongation. Patients were studied with EMG equipment with low-cut filter settings ⩽10 Hz. Using adult cut-offs to define DCMAPD prolongation it was present in 8/8 patients for peroneal nerve, in 6/8 for median nerve and in all five patients in which we recorded tibial nerve. During follow-up time clinical worsening corresponded always to a greater DCMAPD prolongation compared with other electrophysiological parameters (amplitude, distal latency and nerve conduction velocity). Appropriate evaluation of DCMAPD appears an essential criterion to consider in assessing suspected CIDP and to support clinical worsening in follow-up, which may be helpful in limiting extensiveness and duration of electrophysiological testing, thereby reducing patient discomfort, especially in children.

Optimized cartilage visualization using 7-T sodium ((23)Na) imaging after patella dislocation.

Retropatellar cartilage lesions often occur in the course of recurrent patella dislocation. Aim of this study was to develop a more detailed method for examining cartilage tissue, in order to reduce patient discomfort and time of care. For detailed diagnosing, a 7-T MRI of the knee joint and patella was performed in nine patients, with mean age of 26.4years, after patella dislocation to measure the cartilage content in three different regions of interest of the patella. Axial sodium ((23)Na) images were derived from an optimized 3D GRE sequence on a 7-T MR scanner. Morphological cartilage grading was performed, and sodium signal-to-noise ratio (SNR) values were calculated. Mean global sodium values and SNR were compared between patients and volunteers. Two out of nine patients showed a maximum cartilage defect of International Cartilage Repair Society (ICRS) grade 3, three of grade 2, three of grade 1, and one patient showed no cartilage defect. The mean SNR in sodium images for cartilage was 13.4±2.5 in patients and 14.6±3.7 in volunteers (n.s.). A significant negative correlation between age and global sodium SNR for cartilage was found in the medial facet (R=-0.512; R (2)=0.26; p=0.030). Mixed-model ANOVA yielded a marked decrease of the sodium SNR, with increasing grade of cartilage lesions (p<0.001). Utilization of the (23)Na MR imaging will make earlier detection of alterations to the patella cartilage after dislocation possible and will help prevent subsequent disease due to start adequate therapy earlier in the rehabilitation process. II.

Orange juice intake reduces patient discomfort and is effective for bowel cleansing with polyethylene glycol during bowel preparation.

Many patients report discomfort because of the unpleasant taste of bowel preparation solutions. This study aimed to determine whether adding orange juice to 2 L of polyethylene glycol plus ascorbic acid is effective for reducing patient discomfort and improving palatability during bowel preparation. This was a single-blinded, randomized controlled trial. The study was conducted at a tertiary referral hospital and a generalized hospital. Consecutive outpatients and inpatients were randomly allocated to drink 2 L of polyethylene glycol-ascorbic acid or 2 L of polyethylene glycol-ascorbic acid with orange juice in a single dose or a split dose. Tolerability, palatability score, willingness, and related adverse events were investigated by questionnaires. Bowel cleansing was rated using the Aronchick scale. Each score was graded on a 5-point scale. A total of 107 patients, 53 in the orange juice group and 54 in the polyethylene glycol-ascorbic acid group who underwent elective colonoscopy were enrolled. The palatability score (mean ± SD) was higher in the orange juice group than in the control group (2.36 ± 0.76 vs 1.78 ± 0.88; p = 0.005). Nausea was less frequent in the orange juice group (26.4% vs 59.3%; p = 0.001). Total amount of bowel preparation ingested was not significantly different between the groups (p = 0.44). The bowel preparation score (mean ± SD) was not significantly different (1.49 ± 0.80 vs 1.43 ± 0.77; p = 0.94). Willingness to repeat the same process was higher in the orange juice group (90.4% vs 66.7%; p = 0.003). This study is limited because only ambulatory patients were enrolled. Orange juice intake before drinking 2 L of polyethylene glycol-ascorbic acid for colonoscopy can reduce patient discomfort, resulting in improved acceptability and patient compliance. This method is as effective for bowel cleansing as polyethylene glycol.

Deformations experienced in the human skin, adipose tissue, and fascia in osteopathic manipulative medicine.

Osteopathic manipulative medicine techniques involve compressive and tangential forces to target the fascia. These forces are transmitted to the skin and adipose tissue before the fascia is encountered. Knowing the extent of deformation of these 2 tissue layers relative to the fascia will assist osteopathic physicians in evaluating techniques for manual therapies and adjusting these therapies to reduce patient discomfort and improve results. To determine the magnitude of the forces transmitted to the skin, adipose tissue, and fascia, and to determine the magnitude of deformation produced in the skin and adipose tissue relative to the fascia using a mathematical model. The large deformation theory of elasticity, valid for 3-dimensional deformations, was used to evaluate the forces that need to be applied such that a specified deformation is produced in any region of the skin, adipose tissue, or fascia layers. Similarly, if the forces are specified, then the deformation produced can be determined. The normal and tangential forces required to produce a deformation of 9% compression and 4% shear for the skin were 50 N and 11 N, respectively. Normal and tangential forces of about 100 N and 22 N were found for a similar deformation of fascia. For adipose tissue, these forces were 36 N and 8 N, respectively. In addition, the skin experienced more compression and shear-about 1.5 times as much as the fascia, and the adipose tissue experienced about 2.5 to 3.5 times the deformation of the fascia and 50% more than the skin when a given force was applied to the skin. The forces applied to the surface of the skin were transmitted through this layer and the adipose layer entirely to the fascia. Therefore, the skin and adipose tissue experienced the same magnitude of force as the fascia. However, the skin and adipose tissue experienced more compression and shear than the fascia.

Paracentesis Catheter Fixator: Introducing a New Instrument and a Pilot Study

Background: Paracentesis is a common bedside therapeutic and diagnostic procedure that requires insertion of a catheter into the peritoneal cavity; however, lack of a specialized fixator for securing the catheter causes frequent catheter kinking and patient discomfort. Objectives: This study aimed to demonstrate the efficacy of a designed paracentesis fixator in reducing patient discomfort and procedure failure rates. Materials and Methods: This interventional study was conducted on 20 patients referred to Imam Khomeini General Hospital for therapeutic paracentesis. A fixator was used to secure the catheter in the experimental group. This designed fixator consisted of an inverted plastic cup with six square-shaped appendages, a cylinder-shaped tube, a flexible silicone hose in continuation of the cylindrical tube, and a connector piece. In the control group, catheter was fixed using tape and sterile gauze. A questionnaire regarding subjective discomfort and overall satisfaction was filled by patients after the procedure. Results: Mean score for subjective discomfort was significantly lower (P = 0.03) and patients’ overall satisfaction was higher in the experimental group (P = 0.04) in comparison to control group. Failure occurred in 20% and 70% of patients in the experimental and control groups, respectively. Coclusions: The designed paracentesis fixator effectively secures the catheter, reduces catheter kinking incidents, and improves patient's comfort and satisfaction.

Endoscopic Versus Bedside Electromagnetic-Guided Placement of Nasoenteral Feeding Tubes in Surgical Patients

BackgroundNasoenteral tube feeding is often required in surgical patients, mainly because of delayed gastric emptying. Bedside electromagnetic (EM)-guided tube placement by specialized nurses might offer several advantages (e.g., reduced patient discomfort and costs) over conventional endoscopic placement. The aim of this study was to compare the success rate of EM-guided to endoscopic placement of nasoenteral feeding tubes in surgical patients. Materials and MethodsA retrospective cohort study was performed in 267 adult patients admitted to two gastrointestinal surgical wards who received a nasoenteral feeding tube by EM-guidance or endoscopy. Eighteen patients were excluded because of insufficient data. Patients were categorized according to the primary tube placement method. Subgroup analysis was performed in patients with altered upper gastrointestinal anatomy. Primary endpoint was successful tube placement at or beyond the duodenojejunal flexure. ResultsA total of 249 patients were included, of which 90 patients underwent EM-guided and 159 patients underwent endoscopic tube placement. Both groups were comparable for baseline characteristics. Primary tube placement was successful in 74/90 patients (82 %) in the EM-guided group versus 140/159 patients (88 %) in the endoscopic group (P = 0.20). In patients with altered upper gastrointestinal anatomy, success rates were significantly lower in the EM-guided group (58 vs. 86 %, P = 0.004). There were no significant differences in tube-related complications such as dislodgement or tube blockage. ConclusionsBedside EM-guided placement of nasoenteral feeding tubes by specialized nurses did not differ from endoscopic placement by gastroenterologists regarding feasibility and safety in surgical patients with unaltered upper gastrointestinal anatomy.

75 Celt ACD®, A Novel Stainless Steel Femoral Artery Closure Device, Reduces Time to Hemostasis, Patient Discomfort and Late Bruising Compared with Angio-seal™

IntroductionThe Celt ACD® (Kimal, Middlesex, U.K.) is a novel stainless steel vascular closure device (VCD). We conducted a prospective, non-randomised study to assess time to hemostasis, patient discomfort and vascular...

Characteristics and clinical impact of stimulation-evoked seizures during extraoperative cortical mapping

Extraoperative electrocortical stimulation mapping (ESM) is used to identify functional cortex prior to epilepsy surgery, with the goal of preserving function postoperatively. Although attempts are made to avoid stimulation-evoked seizure activity, the clinical impact of these events with regard to safety, clinical utility, functional outcome, and even disruption to the procedure itself is unknown. We conducted a retrospective review of 57 patients with pharmacoresistant focal epilepsy who underwent intracranial electrode implantation and ESM. Stimulation-evoked seizures (afterdischarges associated with clinical signs or symptoms) occurred in 19 patients (33%). Mapping sessions were disrupted for 11 of these patients (i.e., 19% of the full sample and 58% of the subgroup of patients with stimulation-evoked seizures). Patients who had ESM disruption were no less likely than patients without ESM disruption to be seizure-free at one year (p=0.63) and two years (p=0.57) postoperatively. Among 23 patients who underwent language assessment pre- and postoperatively, 4 (17%) had evoked seizures that disrupted language mapping; these patients were no more likely to show postoperative language declines relative to those who had no ESM disruption (p=0.26). Results suggest that evoked seizures occur frequently during ESM and can disrupt the procedure; however, these events do not appear to adversely affect postoperative outcomes. Nevertheless, attempts should be made to limit stimulation-evoked seizures in order to reduce patient discomfort, increase efficiency, and maximize the utility of ESM.

Impact of a Structured Duplex Ultrasound Hemodialysis Access Surveillance Program on Access Intervention Rates

Purpose —To assess the impact of a structured duplex ultrasound hemodialysis access surveillance program on the frequency of diagnostic fistulograms and endovascular interventions. Methods —A structured ultrasound hemodialysis access surveillance program was implemented at our institution on March 1, 2010. The access ultrasound comprised the measurement of vessel diameter, velocity, and flow in the feeding artery, anastomosis, and at specific points along the outflow vein (2.5, 5.0, 7.5, and 10 cm beyond anastomosis) along with a waveform pattern in the ipsilateral axillary and internal jugular vein. In this retrospective multicenter study, we compared the frequency of diagnostic contrast fistulograms and endovascular interventions (angioplasty) performed from March 2010 to February 2011 (12 months) by using the implemented ultrasound access surveillance program (postsurveillance) to the preceding 12 month period (March 2009 to February 2010) where no ultrasound access surveillance program was used (pre-surveillance). Results —Within our hemodialysis program, there was an average of 119 active fistulae during the presurveillance period versus 141 in the postsurveillance period. There were no significant demographic differences in our study populations across the two time frames ( p &gt; 0.05). In the presurveillance period, 59 diagnostic contrast fistulograms were performed, whereas 47 diagnostic contrast fistulograms were performed during the post surveillance period. Using a two-sample test for equality of proportions, we found there was a significant decrease in the proportion of diagnostic contrast fistulograms after implementation of an access ultrasound surveillance program ( p = 0.0114). Similarly, 81 endovascular interventions were performed during the presurveillance period, whereas a significantly decreased number of endovascular interventions (n = 50) were performed postsurveillance ( p &lt; 0.0001). Conclusions —There was a significant decrease in the number of invasive diagnostic contrast fistulograms and endovascular interventions upon implementation of an ultrasound access surveillance program. Such a structured surveillance program has the potential to provide significant reduction in patient discomfort and to minimize unnecessary invasive endovascular procedures.

EM reconstruction of dual isotope PET using staggered injections and prompt gamma positron emitters

The aim of dual isotope positron emission tomography (DIPET) is to create two separate images of two coinjected PET radiotracers. DIPET shortens the duration of the study, reduces patient discomfort, and produces perfectly coregistered images compared to the case when two radiotracers would be imaged independently (sequential PET studies). Reconstruction of data from such simultaneous acquisition of two PET radiotracers is difficult because positron decay of any isotope creates only 511 keV photons; therefore, the isotopes cannot be differentiated based on the detected energy. Recently, the authors have proposed a DIPET technique that uses a combination of radiotracer A which is a pure positron emitter (such as(18)F or (11)C) and radiotracer B in which positron decay is accompanied by the emission of a high-energy (HE) prompt gamma (such as (38)K or (60)Cu). Events that are detected as triple coincidences of HE gammas with the corresponding two 511 keV photons allow the authors to identify the lines-of-response (LORs) of isotope B. These LORs are used to separate the two intertwined distributions, using a dedicated image reconstruction algorithm. In this work the authors propose a new version of the DIPET EM-based reconstruction algorithm that allows the authors to include an additional, independent estimate of radiotracer A distribution which may be obtained if radioisotopes are administered using a staggered injections method. In this work the method is tested on simple simulations of static PET acquisitions. The authors' experiments performed using Monte-Carlo simulations with static acquisitions demonstrate that the combined method provides better results (crosstalk errors decrease by up to 50%) than the positron-gamma DIPET method or staggered injections alone. The authors demonstrate that the authors' new EM algorithm which combines information from triple coincidences with prompt gammas and staggered injections improves the accuracy of DIPET reconstructions for static acquisitions so they reach almost the benchmark level calculated for perfectly separated tracers.

Periodontal Microsurgery – A Review

Over the past decade, the field of periodontics has seen increasing surgical refinement of many procedures. Consistent successful periodontal treatment procedures demand clinical expertise that challenges the technical skills of periodontists to the limit of and beyond the range of visual acuity. Periodontal microsurgery is the refinement of basic surgical techniques made possible by the improved visual acuity gained with the use of surgical microscope. The effect of periodontal microsurgery may include more predictable therapeutic results, less invasive procedure with reduced patient discomfort, more rapid healing, improved cosmetic results and greater patient acceptance.

Can Viscosupplementation Be Used in the Hip? An Italian Perspective

Viscosupplementation is the intra-articular administration of preparations containing hyaluronic acid or hyaluronate intended to restore the normal biological properties of hyaluronic acid normally found in synovial fluid. Infiltration of hyaluronic acid in the arthritic hip is a more recent technique than viscosupplementation of the knee due to the greater technical difficulty of infiltration to the hip, which requires fluoroscopic or ultrasound guidance. The introduction of high-molecular-weight hyaluronic acid in the treatment permits a single administration and has helped diffuse hip infiltration treatment. A single infiltration reduces patient discomfort caused by the procedure and allows treatment of a larger number of patients. Although the literature has unequivocally proven the possibility of reducing pain in patients affected by hip arthritis following infiltration, the molecular weight and density, the number of infiltrations required for long-term results, and the most appropriate indications for infiltration treatment have yet to be clarified. Selecting the patient is the first obstacle to be overcome. Therefore, infiltration should be considered as an option for patients with initial pain symptoms who have not yet been listed for joint prosthesis surgery. The radiographic criteria require at least a partly preserved joint space, and the clinical criteria of persistent hip pain and full joint mobility seem to be sufficiently effective for selection.

Ultrasound-guided lumbar puncture as a diagnostic aid to reduce number of attempts and complication rates

Ultrasound-guided lumbar puncture (LP) could be beneficial in situations where anatomical landmarks are difficult to identify. There is some evidence that it is associated with increased success rates and procedural ease. Its effect on complication rates has not been explored. This mixed retrospective-prospective case-control study over 6 months compares unguided (retrospective data, n = 28) and ultrasound-guided LPs (prospective data, n = 23) in non-emergency patients. Presence of factors making LPs difficult (DF) i.e. BMI ≥30 kg/m2, scoliosis and previous lumbar spinal surgery were recorded. There was a significant difference in attempt rates between unguided and ultrasound-guided LPs (median 2 vs. 1; p = 0.01) with complication rates of 50% and 26.1%, respectively ( p = 0.15). In a subgroup analysis, complication rates were significantly different in those with DF (76.9%, unguided LPs (n = 13) vs. 33.3%, ultrasound-guided LPs (n = 12); p = 0.03), with an absolute risk reduction of complications of 43.6% (NNT of 2.3) in ultrasound-guided vs. unguided LPs. In those with DF, the back pain rates were significantly reduced (53.8% unguided LPs vs. 8.3% ultrasound-guided LPs; p = 0.02). In the ultrasound-guided LP group, there was no blood contaminated cerebrospinal fluid samples, whereas this occurred in 14% of unguided LPs. Ultrasound-guidance significantly reduced the number of LP attempts. In those with DF, the use of ultrasound significantly reduced post-procedural complication, particularly back pain. Ultrasound-guidance during LP procedures can reduce patient discomfort and encourage patient safety, thereby improving clinical practice.