Patient-reported outcomes in Primary Spinal Intradural Tumours: a systematic review

STUDY DESIGN

Systematic review.

OBJECTIVES

Primary Spinal Intradural Tumours (PSITs) are rare pathologies that can significantly impact quality of life. This study aimed to review patient reported outcomes (PROs) in PSITs.

METHODS

A systematic search of Pubmed and Embase was performed to identify studies measuring PROs in adults with PSITs. PRO results were categorised as relating to Global, Physical, Social, or Mental health. Outcomes were summarised descriptively.

RESULTS

Following review of 2382 records, 11 studies were eligible for inclusion (737 patients). All studies assessed surgically treated patients. Schwannoma was the commonest pathology (n = 190). 7 studies measured PROs before and after surgery, the remainder assessed only post-operatively. For eight studies, PROs were obtained within 12 months of treatment. 21 PRO measurement tools were used across included studies, of which Euro-Qol-5D (n = 8) and the pain visual/numerical analogue scale (n = 5) were utilised most frequently. Although overall QoL is lower than healthy controls in PSITs, improvements following surgery were found in Extramedullary tumours (EMT) in overall physical, social, and mental health. Similar improvements were not significant across studies of Intramedullary tumours (IMT). Overall QoL and symptom burden was higher in IMT patients than in brain tumour patients. No studies evaluated the effect of chemotherapy or radiotherapy.

CONCLUSION

Patients with PSITs suffer impaired PROs before and after surgery. This is particularly true for IMTs. PRO reporting in PSITs is hindered by a heterogeneity of reporting and varied measurement tools. This calls for the establishment of a standard set of PROs as well as the use of registries.

Mercury exposure and risks from dental amalgam in the US population, post-2000

Dental amalgam is 50% metallic mercury (Hg) by weight and Hg vapour continuously evolves from in-place dental amalgam, causing increased Hg content with increasing amalgam load in urine, faeces, exhaled breath, saliva, blood, and various organs and tissues including the kidney, pituitary gland, liver, and brain. The Hg content also increases with maternal amalgam load in amniotic fluid, placenta, cord blood, meconium, various foetal tissues including liver, kidney and brain, in colostrum and breast milk. Based on 2001 to 2004 population statistics, 181.1 million Americans carry a grand total of 1.46 billion restored teeth. Children as young as 26 months were recorded as having restored teeth. Past dental practice and recently available data indicate that the majority of these restorations are composed of dental amalgam. Employing recent US population-based statistics on body weight and the frequency of dentally restored tooth surfaces, and recent research on the incremental increase in urinary Hg concentration per amalgam-filled tooth surface, estimates of Hg exposure from amalgam fillings were determined for 5 age groups of the US population. Three specific exposure scenarios were considered, each scenario incrementally reducing the number of tooth surfaces assumed to be restored with amalgam. Based on the least conservative of the scenarios evaluated, it was estimated that some 67.2 million Americans would exceed the Hg dose associated with the reference exposure level (REL) of 0.3 μg/m(3) established by the US Environmental Protection Agency; and 122.3 million Americans would exceed the dose associated with the REL of 0.03 μg/m(3) established by the California Environmental Protection Agency. Exposure estimates are consistent with previous estimates presented by Health Canada in 1995, and amount to 0.2 to 0.4 μg/day per amalgam-filled tooth surface, or 0.5 to 1 μg/day/amalgam-filled tooth, depending on age and other factors.

Nursing assessment: impact on type and cost of interventions to prevent pressure ulcers

OBJECTIVE

To describe pressure ulcer preventive interventions and their cost, and to compare the preventive intervention use and cost with level of risk.

DESIGN

Comparative, descriptive design.

SETTING AND SUBJECTS

A large midwestern Veteran's Affairs Medical Center with 260 long-term care beds. Thirty-one chair- or bed-bound residents from 1 long-term care unit comprised the study sample.

MAIN OUTCOME MEASURES

The outcome variables included demographic information (patient record), Braden Risk Assessment score, institutional risk assessment score (Pressure Ulcer Risk Tool), type and frequency of preventive interventions, and the related costs.

METHODS

Subjects were assessed on a weekly basis for type and frequency of preventive intervention and for the development of a pressure ulcer. Each subject was observed until death, discharge, pressure ulcer formation, or the end of the 3-month study period.

RESULTS

The 3-month pressure ulcer incidence rate was 13%. All subjects were at risk for pressure ulcer development according to Braden scores; whereas only 74% were assessed at risk with use of the facility's risk assessment tool. Preventive measures included regular repositioning (87%); 67% were placed on mattress support surfaces. There was no relationship between level of risk (facility risk tool score) and type of prevention used. The total cost of pressure ulcer prevention to the nursing unit was $14,926, representing a mean of $497 per subject, and $5.55 per subject per day.

CONCLUSION

As compared with previous studies, the higher cost of prevention described in this study may be attributed to inadequate linkage of preventive interventions to risk level.

Estimating fish consumption rates for Ontario Amerindians

The routine assessment of human exposure to contaminants requires that exposure via consumption of freshwater fish be considered because many chemicals persist and/or bioaccumulate in fish. Estimates of fish consumption rate were determined for Ontario Amerindians from data on the concentration of mercury in the hair of 4,327 Amerindians residing in 58 reserves across the province, combined with data on mercury concentrations in three commonly consumed species of fish collected from lakes surrounding these reserves. Estimated rates of fish consumption were found to differ between sexes, with males consuming a geometric mean of 19 g of fish per day, while females were estimated to consume a geometric mean of 14 g/day. Fish consumption rate was found to increase with increasing latitude, a surrogate measure of community isolation, and to increase with age. Seasonal variation was also noted, with fish consumption rates being highest during summer months and lowest in winter. These data may provide regulatory agencies with a more statistically representative basis upon which to establish assumptions concerning fish consumption rates for risk assessment purposes. Factors such as the location of the exposed population, age and sex of exposed individuals, and time of year in which an assessment is being conducted, should also be considered as specific situations require.

Cognitive-behavioral therapy for migraine headaches: a minimal-therapist-contact approach versus a clinic-based approach

The efficacy of a clinic-based cognitive-behavioral program for the treatment of common migraine was compared to the same approach using a minimal-therapist-contact format by means of a randomized controlled trial. Forty-eight subjects between 18 and 50 years of age completed the program. Following four weeks of recording headache activity, subjects were randomly assigned to a waiting list control condition or to one of the two treatment conditions. Treatment was followed by four weeks of recording of headache activity immediately posttreatment and again six months later. Multivariate analysis of variance indicated that there was a significant reduction in headache frequency, duration and peak intensity following treatment for both treated groups. These reductions were maintained at six months follow-up. Treatment for the minimal-contact group was significantly more cost-effective than for the clinic group.

Acute toxicity, uptake, and clearance of aminocarb by the aquatic isopod, Caecidolea racovitzai racovitzai

Acute toxicity of aminocarb to the aquatic isopod Caecidolea racovitzai racovitzai was found to be proportional to exposure temperature with the potency of the insecticide increasing 1.3 to 5.2 times when the temperature was increased from 12 to 20 degrees C. The 96-hr LC50 values were determined to be 36.1 and 12.0 mg aminocarb/liter for 12 and 20 degrees C, respectively. Uptake and clearance of aminocarb by C. r. racovitzai were also shown to be proportional to temperature indicating that they may be active processes. Control of clearance may be a function of the rate of metabolism of aminocarb in vivo. Both uptake and clearance were shown to occur in two compartments.