Efficacy of Bilateral Erector Spinae Block in Patients Undergoing Posterior Spine Fusion Surgeries: A Comparative Randomised Controlled Trial

Introduction During spine surgeries, various levels of tissue injury can result in varying hemodynamic responses and significant postoperative pain. Perioperative pain management is essential to controlling hemodynamic responses and postoperative pain management. Erector spinae plane (ESP) blocks can help alleviate this pain by blocking the dorsal rami of the spinal nerve. This study aims to evaluate the efficacy of ESP by assessing the perioperative opioid requirement, hemodynamic parameters, and visual analogue score (VAS) during the postoperative period. Methods In this study, 56 patients underwent elective posterior spine fusion surgeries under conventional anaesthesia and were allocated into two groups: 28 patients were included in the conventional group (Group C) and 28 patients in the ESP group (Group E). Group C patients received 20 ml of 0.9% sodium chloride (NaCl) on each side, and Group E patients received 20 ml of 0.25% bupivacaine + 4 mg dexamethasone on each side under ultrasound sonography guidance. Postoperative pain was assessed using the VAS score. The hemodynamic parameters during the intraoperative period, the time for the first opioid analgesia requirement until 24 hours in the postoperative period, and the amount of cumulative opioid consumption during the perioperative period were observed. Results Postoperative VAS was lower in Group E (P < 0.001). There were significant differences in hemodynamic parameters: heart rate (P < 0.045), systolic blood pressure (P < 0.002), diastolic blood pressure (P < 0.003), and mean arterial pressure (P < 0.002) at the time of incision in Group E. Intraoperative opioid requirements at the time of incision (P < 0.036), 60th minutes (P < 0.023), 120th minutes (P < 0.023), and postoperative opioid requirements at the first hour (P < 0.001), sixth hour (P < 0.004), 14th hour (P < 0.025), 20th hour (P < 0.009), and 24th hour (P < 0.025) had lower opioid requirements in Group E than Group C. Conclusion ESP block is a more site-specific dorsal rami block with a better perioperative hemodynamic profile, a part of multimodal analgesia intraoperatively, and excellent postoperative analgesia with fewer postoperative opioid requirements in multilevel spine fusion surgeries.

Validation of the TNM-8 AJCC classification for HPV-positive oropharyngeal cancers in patients undergoing trans-oral robotic surgery

High-risk human papillomaviruses (HPV) are associated with some oropharyngeal squamous cell carcinomas (OPSCC). HPV-OPSCC have better survival outcomes compared to HPV negative tumours. The new TNM-8 AJCC staging (2018) is based on ICON-S data with 98% of patients treated with primary chemoradiation. To validate the TNM-8 AJCC classification in HPV-OPSCC treated primarily with surgery (trans-oral robotic surgery or open). There were 102 patients with HPV-OPSCC treated between July 2009 and December 2014 at the Royal Adelaide Hospital. The median age was 57 years (range: 38-83) and mostly males (84.5%). 27.2% were active smokers and 50.5% reformed smokers. Early T-stage cancer in 72.8%. Primary treatment was surgery & adjuvant therapy (70%) while primary chemoradiation (30%). Survival analyses were performed for the 7th and 8th AJCC systems. The reclassification to the AJCC 8th edition staging system resulted in a change of 54 patients from stage 4 to stages 1 and 2. This was mainly an effect of changes with N2a and N2b nodal disease being reclassified to N1. Survival outcomes were comparable with the ICON-S data. The new TNM-8 classification is, therefore, validated in a cohort treated, predominantly, with primary surgery and adjuvant therapy.

An Uncommon Case of Brucellar Spondylodiscitis: A Case Report

Introduction

Infective spondylodiscitis refers to simultaneous inflammation of vertebrae and disc and usually occurs through hematogenous spread. The most common presentation of brucellosis is febrile illness, but it can rarely present as spondylodiscitis. Rarely, human cases of brucellosis are diagnosed and treated clinically. We describe a case of previously healthy man in his early 70s who presented with symptoms suggestive of spinal tuberculosis, then diagnosed to have brucellarspondylodiscitis.

Case Report

A 72-year-old farmer presented to our orthopedic department with a history of chronic lower back pain. Spinal tuberculosis was suspected at a medical facilitynear his residence, based on magnetic resonance imaging consistent with infective spondylodiscitis, and the patient was referred to our hospital for further management. Investigations revealed that the patient had an uncommon diagnosis of Brucellar spondylodiscitis for which he was managed accordingly.

Conclusion

Brucellar spondylodiscitis may clinically mimic spinal tuberculosis; hence, it must be considered as a differential diagnosis in a patient presenting with the lower back pain (particularly in the elderly) and signs of a chronic infection. Screening serological testing is vital in early identification and management of spinal brucellosis.

Factors Determining the Functional and Radiological Outcome after Secondary Nailing in Open Fractures of Lower Extremity- A Prospective Cohort Study

Introduction: Open long bone fractures of lower limb are cumbersome to treat. Because of the increased chances of infection, wound debridement and external fixation is the primary procedure followed by a secondary intramedullary nailing when the wound improves. Pin tract infection, loss of fixation, non union is the most frequently encountered complications of external fixation. These complications have discouraged surgeons all over the world in accepting external fixation as a definitive method of fracture treatment. Secondary intramedullary interlocking nailing provides intramedullary input of cancellous tissue at the fracture site due to reaming and nailing. Aim: To evaluate the factors determining the outcome after secondary nailing in open fractures of lower extremity. Materials and Methods: The prospective cohort study was conducted from October 2017 to April 2020 at Pondicherry Institute of Medical Sciences, Pondicherry, India, 33 patients who had open long bone fractures of lower limb and underwent secondary nailing following external fixation, were evaluated. The patients were followed up for a period of six months. Factors such as age, bone involved, grade of injury, timing of debridement, time interval between external fixation and secondary nailing were analysed to see whether they affect the outcome of secondary nailing of open fractures of long bones. All patients underwent an initial thorough wound debridement and external fixation application. A secondary nailing was done once wound had settled down. Age, gender, bone involved, grade of injury, timing of debridement and timing of secondary nailing were noted for all the patients and patients were followed up at six weeks, three months and six months. Final functional outcome (end of six months) was calculated using Lower Extremity Functional Scale (LEFS) and radiological union (end of six months) was calculated using Radiological Union Scale in Tibial fractures score (RUST). Results: There were no statistically significant differences in RUST/LEFS score at the end of six months, with respect to age (p-value=0.825/0.847), gender (p-value=0.235/0.348), bone involvement (p-value=0.726/0.757), grade of injury (p-value=0.107/0.546) and timing of debridement (p-value=0.117/0.374). The mean RUST scores at six weeks, three months and six months were 4.39, 6.57 and 9.28, respectively. The mean LEFS scores at six weeks, three months and six months were 20.96, 34.92, 49.5, respectively. The radiological union rate in this study was 60.61% at the final follow-up. But patients who underwent secondary nailing with 10 days of primary debridement and external fixation had a statistically significant (p-value) better outcome in terms of RUST (p-value at 3 months=0.045)/LEFS (p-value at 6 months=0.030). Conclusion: The interval between external fixation and secondary nailing was found to be a significant determinant of radiological outcome at three months (p-value at 3 months=0.045) and better functional outcome at six months (p-value at 6 months=0.030) with patients undergoing secondary nailing within 10 days of external fixation having a good final outcome. However, the radiological outcome between the two groups was comparable at six months follow-up.

Benchmarking an 11-qubit quantum computer

The field of quantum computing has grown from concept to demonstration devices over the past 20 years. Universal quantum computing offers efficiency in approaching problems of scientific and commercial interest, such as factoring large numbers, searching databases, simulating intractable models from quantum physics, and optimizing complex cost functions. Here, we present an 11-qubit fully-connected, programmable quantum computer in a trapped ion system composed of 13 ¹⁷¹Yb⁺ ions. We demonstrate average single-qubit gate fidelities of 99.5\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\%$$\end{document}%, average two-qubit-gate fidelities of 97.5\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\%$$\end{document}%, and SPAM errors of 0.7\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\%$$\end{document}%. To illustrate the capabilities of this universal platform and provide a basis for comparison with similarly-sized devices, we compile the Bernstein-Vazirani and Hidden Shift algorithms into our native gates and execute them on the hardware with average success rates of 78\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\%$$\end{document}% and 35\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\%$$\end{document}%, respectively. These algorithms serve as excellent benchmarks for any type of quantum hardware, and show that our system outperforms all other currently available hardware.

The growing complexity of quantum computing devices makes presents challenges for benchmarking their performance as previous, exhaustive approaches become infeasible. Here the authors characterise the quality of their 11-qubit device by successfully computing two quantum algorithms.

Incidence and management of incidental durotomy during thoracic and lumbar spine surgeries: a retrospective review in a tertiary care centre

<p class="abstract"><strong>Background:</strong> Incidental durotomy is among the most common complications of spine surgery with reported incidence ranging from 1.7% to 16%. Various management options including primary repair, fascial or fat graft, epidural blood patch, fibrin glue sealant, etc., have been proposed. The purpose of this study is to evaluate the incidence of incidental durotomy and the efficacy of different management options during a five year period at a tertiary care center.</p><p class="abstract"><strong>Methods:</strong> All patients who underwent various surgical procedures in thoracic and lumbar spine from January 2006 - December 2010 in our centre were retrospectively reviewed. Data on demographics, primary diagnosis, associated co morbidities, details of surgical procedure, training level of the operating surgeon, details of the incidental durotomy, the treatment, complications and the postoperative stay were recorded.<strong></strong></p><p class="abstract"><strong>Results:</strong> Of 2270 patients, 1401 patients were included in the study. The incidence of incidental durotomy was 3.49% (49 patients). We found a very high incidence of 33.33% incidental durotomies among patients who underwent revision procedures as compared to 3.23% for patients who underwent primary surgeries. 5.10% of incidental durotomies were caused by fellows under training, 4.27% by junior consultants and 2.92% by senior consultants. Of 49 durotomies, complication were 5 cases of intracranial hypotension, 5 postoperative neurological deficits, 2 deep wound infection, 2 pseudomeningocele and 1 meningitis.</p><p class="abstract"><strong>Conclusions:</strong> The risk of incidental durotomy in thoracolumbar surgeries is high in revision surgeries and when performed by fellows in training. Intraoperative identification and primary repair with suturing or sealant reduces postoperative complications.</p>

Is the Cage an Additional Hardware in Lumbar Interbody Fusion for Low Grade Spondylolisthesis? A Prospective Study

INTRODUCTION

Lumbar interbody fusion has become the standard of care for the management of lumbar instability, where fusion is achieved using bone grafts, cages, etc.

AIM

The aim of the study was to compare the outcomes of the interbody fusion using interbody cage technique and stand alone local bone graft technique.

MATERIALS AND METHODS

A total of 30 patients, operated for single level instability with low grade lytic and degenerative spondylolisthesis of L4-5/L5-S1, were selected and grouped into two groups: Group I (stand alone grafts) and Group II (interbody cage and graft) based on computer generated random numbers. All patients who underwent interbody fusion through conventional open posterior approach were included in the study. Data regarding the time taken for interbody fusion, formaninal height maintenance, disc height restoration, translation, functional scores (VAS,ODI) and operative complications were analysed using in both the groups was collected and a student's-t test was performed to evaluate the difference.

RESULTS

The mean age of patients in Group I was 46.7 years whereas, the mean age of patients in Group II was 43.5 years with mean age of 46.7 years and 43.5 years respectively. Interbody fusion, was achieved in seven and eight months in Group I and II respectively (p>0.05). The clinical results of both groups were comparable and there was no significant difference between the two groups in VAS score (p-0.147) and ODI score (p-0.983). Radiological parameters were also comparable and there was no significant difference between the postoperative measurements of the two groups (p=0.348 for translation, p=0.310 for intervertebral disc height and p=0.135 for foraminal height). One patient in Group I had transient foot drop which recovered, while one in Group II had infection, wound was managed with wound wash and antibiotics and another patient in Group II had pseudoarthrosis.

CONCLUSION

Lumbar interbody fusion with standalone local bone grafts is sufficient in single level low grade spondylolisthesis treated by conventional open surgery.

A process oriented approach to promoting collaborative practice: Incorporating complexity methods

BACKGROUND

Only recently have complexity informed methods been viewed as a strategy for changing health care systems and care delivery.

AIMS

This article reports on participants' perceptions of being involved in a complexity informed educational approach to promote interprofessional collaboration in a system of care for children with disabilities.

METHODS

Over a one-year period, all employees within a network of eight community agencies participated in three day-long workshops. A subset of twenty-four employees participated in eight monthly facilitated discussion groups. The workshops and discussion groups focused on processes rooted in complexity sciences which value small-scale interaction to improve the quality of discovery and shared problem solving. Learning group members (n = 24) and their facilitators (n = 4) participated in interviews and focus groups at the end of the project.

RESULTS

Qualitative content analyses of the transcriptions of the interviews and focus groups revealed that participants identified tangible benefits of the process oriented approach. Challenges related to the lack of structure and emergent nature of the methods were identified.

CONCLUSIONS

Lessons learned include incorporating a gradual shift to emergent methods, fostering ownership from the beginning of the process, providing ongoing training to facilitators, flexibility and use of small-group scenarios.

Spontaneous resolution of postoperative lumbar pseudomeningoceles: A report of four cases

Pseudomeningocele is an extradural cerebrospinal fluid collection arising from a dural defect, that may be congenital, traumatic, or more commonly as a result of postoperative complication. Majority of the postoperative pseudomeningoceles occurring after lumbar spine surgeries are small and resolve spontaneously. However, large pseudomeningoceles are rare and spontaneous resolution of such pseudomeningoceles has not been described. We report four cases of postoperative large lumbar pseudomeningoceles that presented as asymptomatic soft fluctuant swelling over the back which resolved spontaneously. We also reviewed the related literatures and operative records of these patients to find the possible mechanism of occurrence, their management, prevention, and reasons for spontaneous resolution. We conclude that nonoperative management under close observation can be employed for asymptomatic postoperative large lumbar pseudomeningoceles. Surgical exploration and repair should be reserved for symptomatic cases presenting with clinical features of intracranial hypotension, worsening neurology, external fistula or infection, thereby avoiding morbidity and potential complications associated with surgical treatment.

Evaluation of an interprofessional education communication skills initiative

CONTEXT

Interprofessional education of pre-licensure students is viewed as an important precursor to developing healthcare professionals who are able to work collaboratively.

OBJECTIVES

This study conducted a program evaluation of an innovative interprofessional communication skills initiative which incorporated problem-based learning, cooperative learning and standardized patients.

METHODS

The communication skills session consisted of a three-hour, faculty facilitated, interactive format in which teams of five to eight students met to conduct an interview with a standardized patient and develop an interprofessional care plan. The program evaluation included measures of satisfaction, the Interprofessional Education Perception Scale (IEPS), the Readiness for Interprofessional Learning Scale (RIPLS), focus groups and individual interviews.

FINDINGS

A total of 96 students from medical, nursing, physiotherapy, occupational therapy, midwifery, physician assistant and pharmacy programs self-selected to participate in the evaluation. Students rated their satisfaction with the communications skills sessions highly. There were small but statistically significant changes pre- and post-session in the IEPS. Qualitative analyses revealed that students perceived that they had learned about each others' scope of practice and built confidence in their communication skills. The skill of the facilitator and preparation for the experience were perceived to promote the success.

DISCUSSION AND CONCLUSION

The demand for experiential events which provide students with the skills required to interact effectively in healthcare teams is likely to continue with the growing awareness of the need for interprofessional education. A learning experience which incorporates standardized patients and feedback from faculty facilitators can promote authentic interprofessional learning, and develop students' confidence to communicate in a team environment.

Serologic and virologic surveillance of avian influenza in Nigeria, 2006-7

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Serologic and virologic surveillance of avian influenza in Nigeria, 2006-7

Since January 2006, H5N1 avian influenza has affected Nigeria's poultry population causing enormous loss of resources. The current circulating virus is a potential candidate for pandemic influenza which may severely affect the human and animal population worldwide especially in the resource-poor countries. In this study, we report on our field and laboratory surveillance efforts in Nigeria. A total of 1,821 tissue samples, 8,638 tracheal swabs, 7,976 cloacal swabs and 7,328 avian sera were analysed over a period of two years, with 312 positive results [corrected] We recovered 299 isolates of highly pathogenic avian influenza virus H5N1 mainly from the diagnostic samples of poultry kept in backyard, small scale and free range farms. This finding emphasised the role played by these farming systems in the dissemination of avian influenza in Nigeria and highlights the need for a continued surveillance in humans since human-animal interaction is a key feature in Africa. Furthermore, there is a need for the strengthening of border controls. Since October 2007, there has been no reported and confirmed outbreak of avian influenza in Nigeria.

The essential signature of a massive starburst in a distant quasar

Observations of carbon monoxide emission in high-redshift (zeta > 2) galaxies indicate the presence of large amounts of molecular gas. Many of these galaxies contain an active galactic nucleus powered by accretion of gas onto a supermassive black hole, and a key question is whether their extremely high infrared luminosities result from the active galactic nucleus, from bursts of massive star formation (associated with the molecular gas), or both. In the Milky Way, high-mass stars form in the dense cores of interstellar molecular clouds, where gas densities are n(H2) > 10(5) cm(-3) (refs 1, 2). Recent surveys show that virtually all galactic sites of high-mass star formation have similarly high densities. The bulk of the cloud material traced by CO observations, however, is at a much lower density. For galaxies in the local Universe, the HCN molecule is an effective tracer of high-density molecular gas. Here we report observations of HCN emission from the infrared-luminous 'Cloverleaf' quasar (at a redshift zeta = 2.5579). The HCN line luminosity indicates the presence of 10 billion solar masses of very dense gas, an essential feature of an immense starburst, which contributes, together with the active galactic nucleus it harbours, to its high infrared luminosity.

Short-term temporal variation in PM2.5 mass and chemical composition during the Atlanta Supersite Experiment, 1999

Measurements in urban Atlanta of transient aerosol events in which PM2.5 mass concentrations rapidly rise and fall over a period of 3-6 hr are reported. The data are based on new measurement techniques demonstrated at the U.S. Environmental Protection Agency (EPA) Atlanta Supersite Experiment in August 1999. These independent instruments for aerosol chemical speciation of NO3-, SO4(2-), NH4+, and organic and elemental carbon (OC and EC), reconstructed the observed hourly dry PM2.5 mass to within 20% or better. Data from the experiment indicated that transient PM2.5 events were ubiquitous in Atlanta and were typically characterized by a sudden increase of EC (soot) and OC in the early morning or SO4(2-) in the late afternoon. The frequent temporal decoupling of these events provides insights into their origins, suggesting mobile sources in metro Atlanta as the main contributor to early morning PM2.5 and more regionally located point SO2 sources for afternoon PM2.5 events. The transient events may also have health implications. New data suggest that short-term PM2.5 exposures may lead to adverse health effects. Standard integrated filter-based techniques used in PM2.5 compliance monitoring networks and in most past PM2.5 epidemiologic studies collect samples over 24-hr periods and thus are unable to capture these transient events. Moreover, health-effects studies that focus on daily PM2.5 mass alone cannot evaluate the health implications of the unique and variable chemical properties of these episodes.

Congruence between health professionals' and patients' pain ratings: a review of the literature

The literature suggests that health professionals have a tendency to underestimate pain when performing clinical assessments. In addition, it appears that the more clinical experience one has, the greater will be the underestimation of pain. Pain assessment is difficult because of the complex interaction between environment, patient and practitioner variables. Although there is a need for further research in this area, there are clinical implications worthy of consideration. Health professionals need to use a variety of valid and reliable measures, use measures of pain behaviour and disability to complement self-report measures and examine how their own biases and values may influence pain judgements.

Does experience influence judgments of pain behaviour? Evidence from relatives of pain patients and therapists

OBJECTIVE

Judgments about an individual's pain can be profoundly important to sufferers. Relatively few studies have examined variables that may affect observers' judgments of the pain of others. The present article reports two studies investigating the relationship between different kinds of exposure to pain problems and observers' ratings of the pain intensity of patients.

DESIGN

In the first study, 82 observers were classified into groups with positive and negative family histories of chronic pain. They viewed a videotape showing the facial expressions of shoulder pain patients undergoing physiotherapy assessments and rated the pain experienced by the subjects. In the second study, the data from observers having no experience with pain problems were compared with data collected from therapists having considerable experience with pain problems.

RESULTS

Observers with a positive family history of chronic pain attributed greater pain to the patients than those with a negative family history of chronic pain. Professionals' pain judgments were lower than those of control subjects.

CONCLUSIONS

Together, the findings imply that one's experiences with the different problems of pain patients may affect pain judgments. Alternative interpretations of the findings are considered.

Perceptions of important retention and recruitment factors by therapists in northwestern Ontario

Recruitment and retention of health professionals in rural and remote communities are well-known challenges. Although the literature states that lifestyle factors and being from a rural background influence recruitment and retention, much of the research is dated and of limited relevance to rehabilitation professionals. This study reports on a survey of physical therapists (PTs) and occupational therapists (OTs) in northwestern Ontario. Seventy-four percent of the OTs and PTs from this geographically isolated region of Canada responded to a mail survey examining factors that influenced their job recruitment and retention decisions. Availability of leisure and recreation activities, proximity of family of origin, need for OTs and PTs and influence of spouse or partner frequently contributed to recruitment decisions and were also important in retention decisions. Although professional autonomy was an important source of job satisfaction for the respondents, almost one-third reported a feeling of professional isolation. Professional development initiatives appeared to influence job satisfaction but were unlikely to influence working life decisions. The findings suggest that recruitment and retention strategies should be multifaceted to reflect the complexity of therapists' decision-making.

Implementing best practice models by using a consensus-building process

The Family Education Project is an example of how the consensus-building model can be used to gain acceptance of evidence-based practice, and adapt and implement it on the local level. The authors describe the consensus-building process and the lessons learned from implementing family education in one community in order to show how this process may be used to adapt best practice models to meet unique needs within local communities.

Evidence-based practices for services to families of people with psychiatric disabilities

Family psychoeducation is an evidence-based practice that has been shown to reduce relapse rates and facilitate recovery of persons who have mental illness. A core set of characteristics of effective family psychoeducation programs has been developed, including the provision of emotional support, education, resources during periods of crisis, and problem-solving skills. Unfortunately, the use of family psychoeducation in routine practice has been limited. Barriers at the level of the consumer and his or her family members, the clinician and the administrator, and the mental health authority reflect the existence of attitudinal, knowledge-based, practical, and systemic obstacles to implementation. Family psychoeducation dissemination efforts that have been successful to date have built consensus at all levels, including among consumers and their family members; have provided ample training, technical assistance, and supervision to clinical staff; and have maintained a long-term perspective.

Threats of incarceration in a psychiatric probation and parole service

This study of the extent to which probation officers use threats of incarceration when working with clients who have mental illness found that collaboration between probation and parole officers and mental health workers significantly enhances the coercive interactions between officers and their clients. Guidelines for collaboration between criminal justice and mental health systems are called for.

The state of knowledge of the effectiveness of consumer provided services

There is a mixed record of research on consumer delivered services. There has been a great deal of descriptive work that supports the feasibility of consumer provided services. Only a limited number of studies have been reported that focus on outcomes for people who receive services from consumers. This new literature is at a critical juncture. This paper examines the state of research on three types of consumer provided services-consumer operated services, consumer partnership services, and consumers as employees. All these service types include consumers as paid providers who deliver mental health services to others, not primarily for their own benefit. This excludes self-help programs. Research resources need to be focused less on consumer provided services as adjunctive to professional services and more on determining the effectiveness of stand-alone consumer provided services in order to develop evidence to influence policy decisions.

Releasing information to families of persons with severe mental illness: a survey of NAMI members

OBJECTIVE

Guidelines for the treatment of severe mental illness recommend that providers share information with families and involve them in treatment. However, research indicates that consumer-provider-family collaboration is not part of routine clinical practice. This study examined the process of releasing information to families and the types of information they receive.

METHODS

Self-administered surveys were completed by 219 family and consumer members of the National Alliance for the Mentally Ill. The surveys gathered information about their experiences with providers' releasing information. Consumers' attitudes toward collaboration and family members' satisfaction with providers were also measured. Regression analyses examined the relationship between consumers' attitudes toward family involvement and whether providers discussed family involvement or the release of information with consumers. Further analyses examined the relationship between family satisfaction and release of information.

RESULTS

The majority of family respondents (72 percent) reported that they received some specific information about their relative's mental illness. Most families received information about diagnosis and medications, but few received information about the treatment plan. Few consumers reported that their permission was requested to release information to their families. Consumers' attitudes toward their family and toward family involvement were significantly associated with whether they were encouraged by their provider to involve a family member in their treatment. No significant relationship was found between consumers' attitudes and whether their provider discussed the release of information. Family members' satisfaction was positively related to whether they received information from providers.

CONCLUSIONS

The findings suggest that although some information is shared with families, collaboration is not currently part of routine clinical practice.

Impact of vertical dome division on nasal airflow

OBJECTIVE

Vertical dome division is an effective maneuver in nasal tip surgery. Its applications include reduction of the tip projection, increasing tip rotation, narrowing of the domal arch, and correction of lobule asymmetry. Nevertheless, some surgeons avoid this technique, fearing tip deformity and possibly impaired nasal airflow.

RESULTS

In this study, nasal airflow measurements were made before and after septorhinoplasty with vertical dome division. There was no significant change in the airflow before and after septorhinoplasty with vertical dome division. The airflow was negatively affected in 37.5% and improved postoperatively in 25% of patients.

CONCLUSIONS

Despite objective findings of diminished nasal airflow in some patients following vertical dome division, no subjective correlation was identified. Furthermore, during the postoperative testing, alar retraction on all of these patients failed to normalize airflow results, indicating that alar collapse was not contributing to the airflow impairment in those cases. All of the patients were found clinically asymptomatic after surgery.

Guidance for the performance evaluation of three-dimensional air quality modeling systems for particulate matter and visibility

Guidance for the performance evaluation of three-dimensional air quality modeling systems for particulate matter and visibility is presented. Four levels are considered: operational, diagnostic, mechanistic, and probabilistic evaluations. First, a comprehensive model evaluation should be conducted in at least two distinct geographical locations and for several meteorological episodes. Next, streamlined evaluations can be conducted for other similar applications if the comprehensive evaluation is deemed satisfactory. In all cases, the operational evaluation alone is insufficient, and some diagnostic evaluation must always be carried out. Recommendations are provided for designing field measurement programs that can provide the data needed for such model performance evaluations.

Procedures to share treatment information among mental health providers, consumers, and families

Although practice guidelines for the treatment of persons with severe mental illness recommend involving family members in all phases of the treatment process, in many states unclear confidentiality statutes and regulations may present a barrier. This paper describes approaches used by a few locales to clarify confidentiality procedures for releasing information to families. It presents a model of steps that regional systems or local agencies may take to manage this barrier to provider-family collaboration. Policy guidelines must clearly state that release of information to family members requires client consent. A specific form for release of information to families indicating the types of information that may be released is then developed. Verbal release of information and a one-year time limit on release are recommended. The form, which should comply with state statutes and regulations, can then be integrated into routine clinical practice. Providers should be trained to discuss and explore issues about the release of information with both consumers and family members.

Extracranial drainage of cerebrospinal fluid: a study of beta-transferrins in nasal and lymphatic tissues

OBJECTIVE

To determine whether an alternative route of cerebrospinal fluid (CSF) drainage exists through the nasal mucosa and the cervical lymphatic system.

STUDY DESIGN

A prospective study was carried out on 18 patients at a university teaching hospital.

METHODS

Ten patients undergoing routine endoscopic sinus surgeries and eight patients undergoing neck dissections were recruited for this study. Tissues were sampled from the middle turbinate, nasopharynx, and upper septum in the first group; jugulodigastric lymph nodes and nasopharyngeal tissues were obtained from the second group. Specimens were subjected to immunofixation electrophoresis in an attempt to identify the presence of beta-1 and beta-2 transferrins. Serum samples were obtained from each subject to serve as controls.

RESULTS

All tissue specimens contained beta-1 transferrin; none showed evidence of beta-2 transferrin.

CONCLUSION

Using this technique, an alternate route of CSF drainage through the nose and the cervical lymphatic system could not be confirmed. Nevertheless, a new technique of performing immunofixation in solid tissues for the purpose of beta-transferrin identification is described.

The efficacy of a consumer case management team: 2-year outcomes of a randomized trial

This article reports the results of a randomized trial of a team of case managers who are mental health consumers compared to a team of nonconsumer. Using a repeated measures MANOVA design, consumer case managers were found to be as effective as a team of nonconsumer case managers in maintaining the stability of severely mentally disabled clients served over a 2-year period. Implications for the employment of consumers in mental health services and the vocational capacity of persons with mental illness are discussed.

The working alliance and consumer case management

The Working Alliance Inventory was used to measure the strength of the therapeutic relationship between seriously mentally disabled case management clients and their case managers in a randomized trial of consumer-provided case management services. It was found that while there was no difference in the strength of the alliance between the consumer and nonconsumer teams of case managers, there were positive relationships between alliance and some outcomes, including quality of life, symptomatology, attitudes toward medication compliance, and satisfaction with mental health treatment.

Self-help groups for families of persons with mental illness: perceived benefits of helpfulness

Self-help groups have become important resources for families of persons with mental illness. The present study was an attempt to understand the factors perceived by group members as helpful using Yalom's factors in clarifying the dynamics of groups. Members (N = 202) of the Alliance for the Mentally Ill of Pennsylvania (AMI of PA), an association of self-help groups for families of the mentally ill, were recruited and responded to a self-administered questionnaire. Hierarchical block multiple regression indicated that those AMI members who felt information provision and gaining support and self-understanding from the group process was helpful and were longer term participants in their group were more likely to perceive benefit from belonging to the group. The findings may provide the basis for evaluating and improving self-help group effectiveness and contribute to understanding process factors within a self-help group which members find beneficial. Implications for how these groups can attract and maintain members are discussed.