Use of quaternized cassia galactomannan for hair conditioning.

There is a continuing need for hair care formulas to deliver superior conditioning benefits with highly efficient deposition of hair-enhancing components. In this paper, we describe high-charge-density (3.0 mEq/g) cassia hydroxypropyltrimonium chloride (cassia HPTC), a quaternized galactomannan from the endosperm of Cassia tora and Cassia obtusifolia. Cassia HPTC is shown to participate in the coacervate phase of conditioning shampoos, from which it is deposited onto hair to provide conditioning benefits. Cryo-scanning electron microscopy and time-of-flight secondary ion mass spectrometry were used to observe and characterize the cassia HPTC deposits left on hair. The high-charge-density cassia HPTC resulted in improved deposition efficiency compared with a quaternized guar-containing formula. Cassia HPTC offers benefits as an alternative to traditional cationic polymers as conditioning agents or as an adjunct conditioner to decrease the amount of cationic polymer needed to achieve the desired conditioning performance.

Concerns and expectations in patients presenting with physical complaints. Frequency, physician perceptions and actions, and 2-week outcome.

BACKGROUND: Specific concerns and expectations may be a key reason that people with common physical complaints seek health care for their symptoms. OBJECTIVES: To determine the frequency of symptom-related patient concerns and expectations, physician perceptions and actions, and the relationship of these factors to patient satisfaction and symptom outcome. METHODS: This was a prospective cohort study of 328 adult outpatients presenting for evaluation of a physical complaint. The setting was a general medicine clinic in a teaching hospital. Measures included previsit patient questionnaire to identify symptom-related concerns and expectations; a postvisit physician questionnaire to determine physician perceptions and actions; and a 2-week follow-up patient questionnaire to assess symptom outcome and satisfaction with care. RESULTS: Pain of some type accounted for 55% of common symptoms, upper respiratory tract illnesses for 22%, and other physical complaints for 23%. Two thirds of patients were worried their symptom might represent a serious illness, 62% reported impairment in their usual activities, and 78%, 46%, and 41% hoped the physician would prescribe a medication, order a test, or provide a referral. Physicians often perceived symptoms as less serious or disabling and frequently did not order anticipated tests or referrals. While symptoms improved 78% of the time at 2-week follow-up, only 56% of patients were fully satisfied. Residual concerns and expectations were the strongest correlates of patient satisfaction. CONCLUSIONS: Improved recognition of symptom-related concerns and expectations might improve satisfaction with care in patients presenting with common physical complaints.

How well do internists diagnose common musculoskeletal complaints?

Musculoskeletal complaints are a common reason for outpatient visits to internists, and little training time is devoted to this in the majority of internal medicine residency programs. The objectives of this study were to determine whether rheumatology training improves accuracy in diagnosing common musculoskeletal syndromes and whether this results in decreased cost of diagnosis.Internal medicine residents (n = 43), staff internists (n = 27), and rheumatologists (n = 8) were given 15 written vignettes of common musculoskeletal syndromes. Participants' choices of laboratory tests, radiographs, and consultations were used to calculate cost of evaluation. Diagnostic accuracy for each physician group was compared with the physicians' rheumatology and orthopedic training and with their clinical experience. Cost for evaluation was also compared with diagnostic accuracy and physician experience.Rheumatologists accurately diagnosed 91% of the vignettes, staff internists 75%, and residents 68%. Rheumatologists tended to spend less for evaluation. Those who made correct diagnoses incurred significantly less cost for several vignettes. Rheumatology training for greater than 14 days correlated with improved diagnostic accuracy (p = 0.0001), whereas orthopedic training did not. Staff internists with greater than 6 years of experience had at least 80% diagnostic accuracy (p = 0.02). Internists trained in rheumatology had improved accuracy in diagnosing common musculoskeletal syndromes and tended to incur fewer costs.