Ellen Badger Hospital

OBJECTIVE: The aim of this study was to evaluate the clinical and microbiological results of treatment with the Er:YAG laser and topical gaseous ozone application as adjuncts to initial periodontal therapy in chronic periodontitis (CP) patients. BACKGROUND DATA: Although many studies have evaluated the effectiveness of the Er:YAG laser as an adjunct to initial periodontal therapy, few studies have focused on the use of gaseous ozone as an adjunct. MATERIALS AND METHODS: Thirty patients with CP were randomly divided into three parallel groups, each composed of 10 individuals with at least four teeth having at least one approximal site with a probing depth (PD) of ≥5 mm and a sulcus bleeding index (SBI) ≥2 in each quadrant. Groups of patients received: (1) Scaling and root planing (SRP)+Er:YAG laser; (2) SRP+topical gaseous ozone; or (3) SRP alone. The microbiological and clinical parameters were monitored at day 0 and day 90. RESULTS: At the end of the observation period, statistically significant improvements in clinical parameters were observed within each group. Parallel to the clinical changes, all treatments reduced the number of total bacteria and the proportion of obligately anaerobic microorganisms. Although intergroup comparisons of microbiological parameters showed no significant differences, clinical findings, including attachment gain and PD reduction, were found to be statistically significant in favor of the SRP+Er:YAG laser group. CONCLUSIONS: Although statistically nonsignificant, the fact that the obligate anaerobic change was mostly observed in the SRP+Er:YAG laser group, and a similar decrease was noted in the SRP+topical gaseous ozone group, shows that ozone has an antimicrobial effect equivalent to that of the Er:YAG laser.

OBJECTIVE: This study evaluated the prevalence and severity of compassion fatigue (CF) risk among nurses employed in a large southwestern hospital system. BACKGROUND: Compassion fatigue is defined as multifaceted exhaustion stemming from untreated distress that leads to physical and emotional problems. Low morale, increased medication errors, and higher turnover can result. METHODS: A descriptive design was used to identify: 1) the prevalence and severity of CF risk among a sample of registered nurses; and 2) the differences in demographic characteristics correlated with CF risk. RESULTS: Forty-six percent of nurses reported moderate to high CF risk. Compassion fatigue risk was significantly associated with years of employment, unit worked, job changes, and use of sick days. CONCLUSION: This study reports new knowledge about compassion fatigue, established risk profiles across clinical units, and clarified optimal timing for interventions for those at the highest risk for CF.

In Brief Each of the successful treatment options for men with prostate cancer is accompanied by its unique side effect profile. However, treatment with androgen deprivation therapy (ADT) and the resulting castrate level of testosterone lead to profound changes in one's physical appearance. The goal of this descriptive study was to describe the relationship between changes in body image and quality of life (QOL) among prostate cancer survivors based upon whether or not treatment was with ADT. A convenience sample of 132 men (aged ≥60 years) with prostate cancer were recruited from the oncology and urology outpatient departments at an urban Veterans Affairs Medical Center. The participants completed 2 established questionnaires, the Body Image Scale and the Quality of Life Index-Cancer Version. Descriptive and inferential statistics were used in the analysis. There was no difference in QOL based on ADT. There was a significant negative correlation between body image dissatisfaction and QOL. The findings add to our knowledge regarding body image and QOL among men with prostate cancer, provide a foundation for future research endeavors, and support the development of evidence-based interventions to mitigate body image dissatisfaction. Each of the successful treatment options for men with prostate cancer is accompanied by its unique side effect profile. However, treatment with androgen deprivation therapy (ADT) and the resulting castrate level of testosterone lead to profound changes in one's physical appearance. The goal of this descriptive study was to describe the relationship between changes in body image and quality of life (QOL) among prostate cancer survivors based upon whether or not treatment was with ADT. A convenience sample of 132 men (aged ≥60 years) with prostate cancer were recruited from the oncology and urology outpatient departments at an urban Veterans Affairs Medical Center. The participants completed 2 established questionnaires, the Body Image Scale and the Quality of Life Index-Cancer Version. Descriptive and inferential statistics were used in the analysis. There was no difference in QOL based on ADT. There was a significant negative correlation between body image dissatisfaction and QOL. The findings add to our knowledge regarding body image and QOL among men with prostate cancer, provide a foundation for future research endeavors, and support the development of evidence-based interventions to mitigate body image dissatisfaction.

BACKGROUND: When an outbreak of a novel pathogen occurs, some of the most pressing questions from a public-health point of view relate to its transmissibility, and the probabilities of different clinical outcomes following infection, to allow an informed response. Estimates of these quantities are often based on household data due to the high potential for transmission in this setting, but typically a rich spectrum of individual-level outcomes (from uninfected to serious illness) are simplified to binary data (infected or not). We address the added benefit from retaining the heterogeneous outcome information in the case of the 2009-10 influenza pandemic, which posed particular problems for estimation of key epidemiological characteristics due to its relatively mild nature and hence low case ascertainment rates. METHODS: We use mathematical models of within-household transmission and case ascertainment, together with Bayesian statistics to estimate transmission probabilities stratified by household size, the variability of infectiousness of cases, and a set of probabilities describing case ascertainment. This novel approach was applied to data we collected from the early "containment phase" stage of the epidemic in Birmingham, England. We also conducted a comprehensive review of studies of household transmission of influenza A(H1N1)pdm09. RESULTS: We find large variability in the published estimates of within-household transmissibility of influenza A(H1N1)pdm09 in both model-based studies and those reporting secondary attack rates, finding that these estimates are very sensitive to how an infected case is defined. In particular, we find that reliance on laboratory confirmation alone underestimates the true number of cases, while utilising the heterogeneous range of outcomes (based on case definitions) for household infections allows a far more comprehensive pattern of transmission to be elucidated. CONCLUSIONS: Differences in household sizes and how cases are defined could account for an appreciable proportion of the reported variability of within-household transmissibility of influenza A(H1N1)pdm09. Retaining and statistically analysing the full spectrum of individual-level outcomes (based on case definitions) rather than taking a potentially arbitrary threshold for infection, provides much-needed additional information. In a future pandemic, our approach could be used as a real-time analysis tool to infer the true number of cases, within-household transmission rates and levels of case ascertainment.

BACKGROUND: Childhood cancer profoundly impacts the well-being of many parental caregivers in the United States yearly. Empirical evidence is extensive for negative well-being and scarce for positive well-being in this population. OBJECTIVE: Study aims were to (1) describe resilience, self-transcendence, and positive (general well-being) and negative well-being (depression and anxiety); (2) examine if caregiver-related personal factors (resilience and/or demographic characteristics) and/or child-related contextual factors (child's cancer and/or demographic characteristics) are associated with well-being; and (3) test if self-transcendence mediates the relationship between resilience and well-being. METHODS: A cross-sectional study whereby 80 caregivers of children diagnosed with childhood cancer for at least 2 months completed study questionnaires. Descriptive statistics explored sample demographics, well-being, self-transcendence, and resilience levels. Bivariate correlations examined factors associated with well-being. One-way analysis of variance and independent-samples t tests explored differences in well-being across levels of independent variables. Baron and Kenny's mediation analysis tested if self-transcendence mediated the relationship between resilience and well-being. RESULTS: Positive well-being and negative well-being coexist in parental caregivers. No child-related contextual factors related to caregivers' well-being. Parental caregivers' resilience and self-transcendence positively related to their general well-being and negatively related to their depression and anxiety. Satisfaction with current financial status positively related to general well-being and negatively related to depression. Self-transcendence mediated the relationship between resilience and well-being. CONCLUSIONS: Findings confirm the importance of focusing on both positive and negative well-being, their associated factors, and mediators. IMPLICATIONS FOR PRACTICE: The authors discuss practice implications to enhance self-transcendence such as journaling, mindfulness techniques, activities to connect with nature, and others.

A 74-year-old man with multiple chronic medical problems was hospitalized for respiratory distress. He experienced recurrent aspiration and required frequent suctioning and endotracheal intubation on several occasions. The patient was deemed competent and steadfastly refused feeding tube placement. The patient demanded that he be allowed to eat a normal diet despite being told that it could lead to his death. The patient wanted to go home, but there was no one there to care for him. Additionally, neither a nursing home nor hospice would accept him in his present condition. The case is especially interesting because of the symbolic value of food and the plight of the patient who has no alternative to hospitalization. The hospital staff experienced considerable stress at having to care for him. They were uncertain whether their obligation was to respect his autonomy and continue to provide food or to protect his health by avoiding aspiration, pneumonia, and possible death by denying him food. This ethical dilemma posed by the professionals' duty to do what is in the patient's best interest versus the patient's right to decide treatment serves as the focus for this case study. Ethical, legal, and healthcare practitioners' considerations are explored. The case study concludes with specific recommendations for treatment.

Background Providing safety-netting advice (SNA) in out-of-hours (OOH) primary care is a recognised standard of safe care, but it is not known how frequently this occurs in practice. Aim Assess the frequency and type of SNA documented in OOH primary care and explore factors associated with its presence. Design and setting This was a retrospective cohort study using the Birmingham Out-of-hours general practice Research Database. Method A stratified sample of 30 adult consultation records per month from July 2013 to February 2020 were assessed using a safety-netting coding tool. Associations were tested using linear and logistic regression. Results The overall frequency of SNA per consultation was 78.0% (1472/1886), increasing from 75.7% (224/296) in 2014 to 81.5% (220/270) in 2019. The proportion of specific SNA and the average number of symptoms patients were told to look out for increased with time. The most common symptom to look out for was if the patients’ condition worsened followed by if their symptoms persisted, but only one in five consultations included a timeframe to reconsult for persistent symptoms. SNA was more frequently documented in face-to-face treatment-centre encounters compared with telephone consultations (odds ratio [OR] 1.77, 95% confidence interval [CI] = 1.09 to 2.85, P = 0.02), for possible infections (OR 1.53, 95% CI = 1.13 to 2.07, P = 0.006), and less frequently for mental (versus physical) health consultations (OR 0.33, 95% CI = 0.17 to 0.66, P = 0.002) and where follow-up was planned (OR 0.34, 95% CI = 0.25 to 0.46, P <0.001). Conclusion The frequency of SNA documented in OOH primary care was higher than previously reported during in-hours care. Over time, the frequency of SNA and proportion that contained specific advice increased, however, this study highlights potential consultations where SNA could be improved, such as mental health and telephone consultations.

Objective : the aim of the AQUARELLE trial was to evaluate the efficacy of divozilimab compared with a historical control (placebo) and to characterise its safety in patients with neuromyelitis optica spectrum disorder (NMOSD). Material and methods . The AQUARELLE clinical trial population included patients aged 18 years and older with a diagnosis of NMOSD established in accordance with the international consensus diagnostic criteria for NMOSD (2015). The primary efficacy endpoint was the mean annual rate of confirmed exacerbations (MAR) over 6 months of treatment with divozilimab compared with a historical control, which was the placebo from the N-MOmentum study. Results. A total of 105 patients received treatment with the investigational drug divozilimab. At the time of analysis, the proportion of patients without confirmed exacerbations was 94.3% (99/105); the ARR was 0.124 (95% CI 0.056–0.276). The ARR ratio for divozilimab /historical placebo was 0.172 (90% CI 0,083–0,359), indicating the superiority of divozilimab compared to historical placebo over 6 months of therapy. During divozilimab therapy, a therapy-related decrease in lymphocyte count was reported in 16 (15.2%) patients, and infusion reactions were reported in 6 (5.7%) patients. The overall incidence of therapy-related infectious events was 6 cases (5.7%). Conclusion. Within patients with NMOSD, the use of divozilimab reduces the risk of exacerbations. The good tolerability of the drug allows divozilimab to be recommended as a new therapeutic option for patients with NMOSD.