Patients with prosthetic joints: Are they at risk when receiving invasive dental procedures?

Most prosthetic joint infections (PJI) are due to wound contamination at the time of surgery. Some infections occur due to the hematogenous spread of bacteria from distant sites of infection. A review of the literature fails to associate PJI with transient bacteremias from invasive dental procedures. Several authors have described conditions which, they believe, render patients with prosthetic joints more at risk for infection. Prosthetic joint patients with these "high risk" conditions have the same types of infecting organisms as other patients with PJI. This indicates that the infecting bacteria are from wound contamination or distant sites of infection and not related to dental procedure bacteremias. Based on this review, antibiotic prophylaxis is not indicated for patients with prosthetic joints when receiving invasive dental procedures, since there is no proven benefit and there are known risks involved with the use of antibiotics. However, the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS), in an advisory statement, suggest prophylaxis for "high risk" patients. The ADA and AAOS recommend a single dose of amoxicillin, cephradine, or clindamycin when prophylaxis is selected. The dentist is ultimately responsible for making treatment recommendations for his or her patients.     

Facilitating Perinatal Grieving Between the Mother and the Father

Society often expects mothers and fathers to share equally in the perinatal grief process because the child was a common bond between them. Unfortunately, in perinatal grief, this is not always the case. The mother and the father can experience incongruent grieving and use discordant coping mechanisms. It is important to evaluate these differences to facilitate communication between the distraught parents. Improved communication can in turn facilitate the grieving process.     

Cytokines as therapeutic drugs.

Cytokines are a growing group of proteins that are responsible for the communication of cells of the immune system, hematopoietic cells, and other cell types. They play a dominant role in various diseases, particularly in promoting and perpetuating inflammation. Cytokine production is a reaction of the body to a pathologic state to restore homeostasis. In such cases, the therapeutic intervention should support the reaction of the body by giving the cytokine itself (agonistic therapeutics). In other cases, manifestation of a disease results from an overproduction of cytokines, making cytokine antagonists desirable therapeutic drugs. Furthermore, cytokines may be good candidates as cancer therapeutics, especially to support the restoration of blood cell populations after chemotherapy or radiation.     

Doppler echocardiography of 119 normal-functioning St Jude Medical mitral valve prostheses: a comprehensive assessment including time-velocity integral ratio and prosthesis performance index.

The purpose of this study was to provide, in a large number of patients, comprehensive Doppler echocardiographic assessment of normal St Jude Medical mitral valve prosthesis function using Doppler-derived hemodynamic variables, including the mitral valve prosthesis-to-left ventricular outflow tract time-velocity integral ratio and prosthesis performance index. The pressure half-time was less than 130 milliseconds in all patients, and all but one patient had either a peak early mitral diastolic velocity of 2 m/s or less or a mitral valve prosthesis-to-left ventricular outflow tract time-velocity integral ratio of less than 2.2. There was a significant (P < .001) negative correlation between the prosthesis performance index and prosthesis size. This negative correlation suggests that there is more efficient use of the in vitro geometric orifice area with smaller prostheses.     

Incisor trauma in an adolescent Arab population: prevalence, severity, and occlusal risk factors.

INTRODUCTION: Incisor trauma is a significant clinical problem in children and adolescents. The purposes of this study were to report on the prevalence and severity of incisor trauma in a large population-based sample of adolescent Kuwaiti residents in the early permanent dentition, to determine the ages of and reasons for the injuries, and to test for any effects of sex, incisor occlusion, and lip coverage on the prevalence of incisor trauma. METHODS: Presence and type of traumatic injury were scored according to the National Institute of Dental Research index in a population-based sample of 795 girls and 788 boys with a mean age of 13.24 years (SD 0.42). RESULTS: Trauma prevalence was higher (P < .001) in boys (19.3%) than in girls (9.7%), and in the maxilla (13.6%) than in the mandible (1.5%). Most (77.3 %) of the affected subjects had only 1 injured tooth, and most (83.7%) of the traumatized teeth were maxillary central incisors. A total of 90.3% of the injuries were unrepaired enamel or enamel/dentin fractures. The major reasons for the injuries were falls and blows indoors (48.4%) or outdoors (41.6%). Nearly two-thirds (63.0%) of the traumas occurred at age 10 years or later. Mean overjet (OJ) was larger (3.9 v 3.0 mm, P < .01), and lip incompetence more frequent (12.7% v 7.3%, P < .01) among the subjects with injured maxillary incisors than among those without. Logistic regression showed that the odds of maxillary incisor trauma were 2.8 times higher in subjects with OJ between 6.5 and 9.0 mm, and 3.7 times higher in subjects with OJ > or = 9.5 mm than in subjects with OJ < or = 3.5 mm. CONCLUSIONS: Multiple logistic regression showed that the risk of maxillary incisor trauma was about 2 times higher in boys than in girls, and that the risk increased by 13% for every millimeter of increase in OJ. Lip competence was not included in the model. No associations were found between occlusion and mandibular incisor trauma.     

Genetics: Changing Health Care in the 21st Century

Advances in human genetics are rapidly changing the scope of information and care that can be provided to health care consumers. By the year 2005 it is expected that the entire human genome will be mapped and all 70,000–100,000 genes will be identified. Currently, there are more than 5,000 known single-gene disorders. With the movement of specialized health services into the primary care setting, nurses increasingly will need to be knowledgeable about genetic disorders, screening/diagnostic tests, and implications for health care. In addition, the management of genetic information raises issues of informed consent, privacy and confidentiality, truth telling and disclosure, and nondiscrimination.     

Are Continuity Clinic Patients Less Satisfied When the Resident Is Postcall?

Due to recent public debate and newly imposed resident work hour restrictions, we decided to investigate the relationship of resident call status to their ambulatory patients' satisfaction. Resident continuity clinic patients were asked to rate their level of satisfaction on a 10-point Likert-type scale. Using multiple regression approaches, these data were then assessed as a function of resident call status. We found that in 646 patient encounters, patient satisfaction scores were significantly less when the resident was postcall, 8.99 ± 1.8, than when not postcall, 9.31 ± 1.3. We herein discuss etiologies and implications of these findings for both patient care and medical education.     

The lived experience of home total parenteral nutrition: an online qualitative inquiry with adults, children, and mothers.

BACKGROUND: The purpose of this study was to access a sample of short-bowel patients receiving home total parenteral nutrition (HTPN) in their home environment and describe their HTPN experience using qualitative methodology. METHODS: Three semistructured, open-ended, in-depth interviews were conducted online over a 5-month period with 6 adults (aged 27 to 45 years) who received HTPN for 2 to 8 years, 3 children (aged 8 to 10 years) receiving HTPN since birth, and the children's mothers. The constant comparison method was used to code and categorize data, inductively develop themes, and create a taxonomy (flow chart) of themes from the data. Credibility of data analysis and themes was established by the prolonged engagement with subjects and subject review of themes identified. RESULTS: Six major themes emerged: affirmation of life, infusion-related complications, lifestyle adaptations, self-worth, isolation, and food intake. Within most themes, subjects described similar concerns and reactions. A clear difference occurred within the theme of food intake. Adults reported feeling constantly hungry and challenged with resisting temptation to eat restricted foods. They admitted to lack of consistency in following dietary restrictions and repeated attempts to consume contraindicated foods. Children expressed lack of desire for food and mothers complained of their children's refusal to eat. CONCLUSIONS: Using qualitative methods allowed insight into the HTPN experience and depiction of the daily challenges of being total parenteral nutrition-dependent from patients' and caregivers' perspectives. It provides insight into their reactions and behaviors. By gaining this type of awareness and understanding, clinical protocols and services can be planned that are more likely to derive successful outcomes.     

Challenges in geriatric oral health research methodology concerning caregivers of cognitively impaired elderly adults

Little is known about oral health care behaviors of community-dwelling, cognitively impaired elderly (CIE) persons. Few studies have been conducted regarding the actual provision of oral care for CIE persons or the attitudes and concerns about oral health among their caregivers. The CIE person's ability to perform self-care decreases over time, and the role of the caregiver in daily oral care becomes increasingly important. The purpose of this pilot study was to explore the attitudes toward oral health and identify related concerns among caregivers who care for community-dwelling CIE persons. Caregivers were surveyed by means of a self-administered, mailed questionnaire. To maintain confidentiality, an intermediary was used for recruitment and data collection. Overall, 148 caregivers were invited by an intermediary to participate in the survey; only 21 (14%) consented to participate and returned the questionnaire. This paper discusses some of the numerous methodological challenges identified when an attempt was made to survey caregivers' attitudes toward and barriers to providing oral care for a dependent CIE.