Sella turcica anomalies on lateral cephalometric radiographs of Polish children.

OBJECTIVES: To assess the prevalence of sella turcica anomalies on lateral cephalograms of children with malocclusion. To describe the craniofacial morphology in patients with sella turcica anomalies. METHODS: Lateral cephalograms obtained at ages 8-16 years (n = 431) were assessed for good visibility of cephalometric structures, including the sella turcica, and the absence of craniofacial congenital deformities; finally, 322 cephalograms were included and analysed. Subsequently, anomalies of sella turcica have been identified. Hypertrophic posterior clinoid process, hypotrophic posterior clinoid process and oblique contour of the floor were the abnormalities found that could not be classified based on literature. The study group consisted of 151 cephalograms with abnormal sella turcica, while the control group consisted of 171 cephalograms without any sellar pathology. Data normality has been tested using Shapiro-Wilk test. Correlations with age were made using Spearman correlation coefficient and those with sex were made using independence test with Yate's correction for continuity. Mann-Whitney test was used to compare between groups and subgroups. The level of significance has been established as p < 0.05. RESULTS: Sellar anomalies were found in 151 individuals (46.9%). Statistically significant differences between patients with normal and abnormal sellar morphology were found concerning: Pg:NB (p = 0.0009), 1+:NA (p = 0.0004) and 1-:NB (p = 0.012), indicating a more distal position of jaw structures in subjects with abnormal sella. CONCLUSIONS: The finding that almost 50% of children with malocclusion have sellar abnormalities confirms a general aetiology of malocclusion. Sella turcica assessment should be carried out during cephalometric analysis.

Can a nurse trained in coronary care expedite emergency department management of patients with acute coronary syndromes?

OBJECTIVE: The goal of this study was to determine the effect of a coronary care-trained nurse (CCTN) on transfer times of patients presenting with acute coronary syndromes (ACS) from the emergency department (ED) to the coronary care unit (CCU) for definitive cardiac treatment (DCT). DESIGN: This was a prospective randomized controlled study. SETTING: The study took place in the ED of a metropolitan public teaching hospital in South Australia. PATIENTS: The study sample was comprised of 893 patients who presented to the ED with a complaint of chest pain. INTERVENTION: An experienced senior CCTN was randomly assigned to work in an ED for 16 randomly selected hours per week; comparable hours over the same period without a CCTN in attendance were used as control data. The major endpoint was time to CCU transfer where DCT was completed for patients with ACS. RESULTS: Out of 893 patients assessed as having possible ACS, 91 (10%) were admitted to the CCU, 47 with a diagnosis of unstable angina pectoris (UAP) and 44 with a diagnosis of acute myocardial infarction. Nineteen patients required thrombolysis and/or percutaneous coronary angioplasty. Mean times (in minutes) to transfer for DCT (95% CI) were 102 (70-134) and 117 (95-139) in the presence and absence of a CCTN, respectively, for all ACS, and 33 (10-55) and 54 (25-82), respectively, for acute myocardial infarction requiring thrombolysis and/or percutaneous coronary angioplasty. CONCLUSIONS: These pilot data show a nonsignificant trend suggesting that DCT is expedited by assignment of senior CCTNs to EDs and provides direction for further study.

Is informed consent to clinical trials an "upside selective" process in acute coronary syndromes?

METHODS: Patient understanding of clinical trial details was assessed on 2 occasions (10 +/- 4 and 24 +/- 3 hours after randomization) in 20 patients enrolled for randomized investigation of pharmacotherapy for unstable angina pectoris or non-Q-wave myocardial infarction in the Platelet IIb/IIIa Antagonist for the Reduction of Acute Coronary Syndrome Events in a Global Organized Network (PARAGON B) and Organization to Assess Strategies in Ischemic Syndromes (OASIS-2) trials. RESULTS: Initial total score for understanding of 52.0% (+/-15.7%) of maximal values improved to 67.7% (+/-18.3%) at repeat interview (P <.001). The mean initial score for knowledge of potential benefit was 85.0% (+/-33.3%) with no significant improvement at repeat interview. Scores for knowledge of risk improved from 35.0% (+/-36.6%) to 68.2% (+/-41.2%) at repeat interview (P <.005). Significant determinants of poor initial score were female sex, limited education, and presence of pain during the consent process; young age was the only determinant of improvement on repeat assessment. CONCLUSION: Thus initial understanding of the research protocols for patients with unstable angina pectoris or non-Q-wave acute myocardial infarction was imperfect, with far greater impairment of knowledge of risk than of benefit.

The role of ST-segment monitoring in assessment of acute myocardial infarction.

Continuous ST-segment analysis is an accurate and noninvasive tool for monitoring coronary artery patency in patients with acute myocardial infarction. This type of monitoring also is easy to use and cost-effective. The critical care nurse plays a pivotal role in initiating ST-segment monitoring, promptly detecting ST-segment changes, and rapidly intervening to achieve myocardial reperfusion.

Early detection and management of right ventricular infarction: the role of the critical care nurse.

Patients with acute inferior myocardial infarction (IMI), complicated by a more extensive right ventricular infarction (RVI), have an increased risk of both complications and mortality. The critical care nurse plays an important role in 1) the early detection of RVI and 2) the management of the common hemodynamic and conduction disturbances that can typically arise.